Health Insurers Fall as Pfizer CEO Says Trump Wants PBM Reform

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(Bloomberg) -- Shares of pharmacy benefit managers extended losses Tuesday after Pfizer Inc. Chief Executive Officer Albert Bourla said President-elect Donald Trump is “very committed” to reforming drug-industry middlemen.

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Bourla’s remarks, following comments from Trump Monday and continued criticism from members of Congress, suggest pharmacy benefit managers are unlikely to see relief from political scrutiny during a second Trump term.

UnitedHealth Group Inc. shares fell as much as 4.5%, CVS Health Corp. dropped as much as 3.9% and Cigna Group slid as much as 4.1% after Bourla’s comment.

“The president has very strong views” on PBMs, Bourla said during a call with analysts following the company’s newly issued 2025 guidance, adding that Trump “wants transparency.”

“It seems to me that he is very committed to make this happen,” Bourla said.

UnitedHealth, CVS and Cigna, which own the largest prescription drug middlemen, also saw their shares sink Monday after Trump criticized the system in a news conference.

“You know the middleman, right?” Trump told reporters Monday. “The horrible middleman that makes more money frankly than the drug companies, and they don’t do anything except they’re a middleman,” he said. “We’re going to knock out the middleman.”

These businesses have been blamed by both Republicans and Democrats for driving up the cost of medicine.

“PBMs are currently in a negative headline spiral,” Leerink Partners analysts said in a note to clients late Monday.

Trump made his middlemen comment after a dinner he had with leaders from Pfizer, Eli Lilly & Co. and his nominee to lead the Department of Health and Human Services, Robert F. Kennedy Jr.

Congress is considering restrictions on PBMs in a year-end spending package that could change the way they get paid, Bloomberg Government reported Dec. 13. The Pharmaceutical Care Management Association, which represents the companies, said in a statement Monday that such a move would raise costs.

Separately, a bipartisan group of lawmakers introduced a bill last week that would force companies that own insurers or PBMs to divest their pharmacy businesses. If it were to become law, it could disrupt a profitable and growing segment for health conglomerates.

“Assuming these proposals make it to enactment it would force some adjustments to business models and profit streams but is far from the most draconian potential proposals such as forced divestitures of owned pharmacies,” the Leerink analysts wrote.