I spent over two decades watching this system get built from the inside, so to many of us, the recent class action lawsuit against Express Scripts isn't a surprise, it's a reckoning that's been a long time coming.

The Break Up Big Medicine Act — introduced by the unlikely bipartisan pairing of Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) — is designed to dismantle vertical integration in healthcare. And while the bill will cause significant disruption for the investors and executives who've built these vast healthcare empires, the case for it is hard to ignore.

If we actually want to lower what people pay at the pharmacy counter, we need transparency, accountability, and real guardrails on the gatekeepers who control access to medicines. I negotiated inside this system for years. The math doesn’t lie — and until we fix how the money flows, patients will keep paying the price.

Trump RX has great potential, but without putting other guardrails in place it will be another windfall for middlemen in the drug supply chain.

If you’ve ever wondered why a trip to the pharmacy can feel like highway robbery, the answer often comes down to three little letters: PBM. These are the middlemen—pharmacy benefit managers—who are supposed to negotiate lower drug prices on behalf of patients and employers. But according to the Federal Trade Commission (FTC) and Congressman James Comer (R-KY), the “help” PBMs provide is actually costing us more, while they reap the benefits.