Bobby Jindal, former governor of Louisiana, said recent pharmacy benefit manager (PBM) reforms represent a step toward increasing transparency in the drug pricing system and reducing misaligned incentives in the pharmaceutical supply chain.
Jindal said he views the changes as part of a broader push for greater accountability in health care spending, including increased scrutiny of employer-sponsored health plans.
“Congress included significant pharmacy benefit manager (PBM) reforms in the 2026 spending package that strengthened transparency and rebate pass-through requirements—policies aimed at shifting financial incentives away from industry middlemen and toward patient care. Market-driven innovations such as TrumpRx have demonstrated the benefits of making drug pricing more transparent and directly accessible to consumers. PBM reforms show that transparency and accountability can gain traction across party lines,” Jindal said, according to Newsweek.
The debate over PBMs has intensified in recent years as the companies have become central intermediaries in determining prescription drug prices and access for millions of Americans.
According to a Federal Trade Commission (FTC) staff report, PBMs sit at the center of the prescription drug supply chain for hundreds of millions of people in the United States. The agency has warned that industry consolidation has left a small number of firms with significant control over pricing, pharmacy networks, and formulary placement.
Regulators have also raised concerns that opaque contracting practices and vertically integrated business models may reduce competition and limit visibility into drug spending for employers, patients, and oversight agencies.
FTC data illustrates the degree of concentration in the market. The agency found that the three largest PBMs processed nearly 80% of the roughly 6.6 billion prescriptions filled in 2023. The top six PBMs accounted for more than 90% of all prescriptions, meaning a small group of companies effectively influences reimbursement rates, drug access, and pharmacy participation across the country.
The FTC has also identified large markups within affiliated pharmacy networks. From 2017 through 2022, pharmacies affiliated with the three largest PBMs generated more than $7.3 billion in dispensing revenue above estimated acquisition cost on specialty generic drugs. The agency reported that 63% of those drugs were marked up by more than 100%, while 22% were marked up by more than 1,000%, including medications used to treat serious conditions such as cancer and HIV.
The commission’s broader investigation into PBM practices has included multiple reports and enforcement actions examining pricing behavior in the pharmaceutical supply chain. In September 2024, the FTC filed a lawsuit against Caremark Rx, Express Scripts, and OptumRx, along with affiliated group purchasing organizations. The agency alleged that rebate practices contributed to artificially inflated insulin list prices and encouraged the use of higher-cost drugs, harming patients.
Jindal is currently chair of Healthy America at the America First Policy Institute, where health care reform and public health are among his stated policy priorities. He also previously served as governor of Louisiana and as assistant secretary at the U.S. Department of Health and Human Services.
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