Dear Reader,
As we entered 2026, many drugmakers moved to raise U.S. prices on hundreds of branded medicines, according to reporting from Reuters. Those headlines make it sound like the story begins and ends with the manufacturer.
But what you pay at the pharmacy counter is often shaped by a less visible part of the system: pharmacy benefit managers (PBMs). As KFF explains, PBMs manage drug benefits for insurers and employers by building formularies, setting pharmacy networks, and negotiating prices and rebates that influence which drugs are “preferred.”
Wall Street has been making headlines lately for piling into a strange new money move.
And it could affect you and your money in a MAJOR way.
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Why This Matters
For investors, this means healthcare inflation isn’t just a government statistic — it’s a cash-flow issue that can hit households month after month. For retirees on fixed incomes, a formulary change or a new “preferred pharmacy” rule can turn a manageable copay into a budget problem.
In plain terms, PBMs decide which drugs get the best coverage placement, and they often steer volume toward certain pharmacies or certain brand-name drugs. The Federal Trade Commission has highlighted concerns that dominant PBMs can raise costs for patients and pressure unaffiliated pharmacies, according to the FTC’s PBM interim staff report materials.
Practical steps that actually help:
Compare prices at the counter by asking the pharmacist for the cash price versus your insured price.
Ask the doctor, “Is there a lower-cost option in the same drug class, or a different dose form that’s covered better?”
Use your plan’s drug-lookup and pharmacy-network tools before you refill, not after you’re surprised at checkout.
If you’re nearing retirement, price your “core prescriptions” the same way you’d stress-test a household budget for insurance and property taxes.
Where Things Stand
Policy pressure is building. Congress continues to consider PBM transparency and spread-pricing limits, including proposals like the PBM Price Transparency and Accountability Act text on Congress.gov. States are also pushing their own reforms aimed at rebates and spread pricing, as summarized by the Council of State Governments’ review of recent PBM-focused state actions at CSG South.
The Patriot Perspective
You can’t control the drug supply chain, but you can control how you navigate it. The steady move is to shop your prescriptions like any other major recurring bill, ask better questions before you refill, and keep your healthcare budget built on real prices — not assumptions.
Stay steady,
Kenneth Boyd
Author, Finance Writer, Former Investment Advisor & CPA