As the incoming administration prepares for a return to leadership, the 118th Congress must stand firm against last-ditch efforts to embed damaging government mandates into our health care system. Misguided policies—whether tucked into end-of-year spending packages or disguised as reform—risk devastating consequences for Medicare Part D, America’s seniors, and taxpayers alike.
One such policy, pushed by the pharmaceutical industry, is known as “delinking.” This proposal would decouple pay from performance for pharmacy benefit managers (PBMs), the entities negotiating savings with drug manufacturers. By removing these performance-based incentives, delinking would stifle
competition, inflate drug prices, and drive up premiums for seniors enrolled in Medicare Part D.
Consider this: the Medicare Part D program is already grappling with significant changes introduced by the Biden Administration’s Inflation Reduction Act (IRA). Before Congress even contemplates layering on new government mandates, we must first assess the IRA’s full impact. The stakes are too high to risk further destabilization of a program that millions of seniors depend on.
“Delinking” provisions would disincentivize PBMs from securing greater rebate savings from drug companies – a model proven to increase health care costs. Under this framework, negotiated rebates would shrink, leading to higher premiums for seniors, estimated at an additional $13 billion annually in the
Medicare Part D program. The ripple effects would extend far beyond premiums, with patients cutting back on coverage and services, resulting in worsened health outcomes and increased spending by taxpayers.
Contrary to claims by pharmaceutical companies, “delinking” wouldn’t lower drug prices. In fact, it would likely lead to higher list prices, funneling profits back into the hands of the very companies advocating for these changes. Instead of incentivizing affordability, this model rewards manufacturers for driving up costs, eroding the competitive forces that currently help keep premiums and out-of-pocket expenses in check. Pharmaceutical companies’ influence doesn’t stop with policy proposals.
Their direct-to-consumer (DTC) advertising floods television and social media, steering patients toward expensive brand-name drugs even
when cheaper, equally effective alternatives exist. These ads likely help drug companies boost their profits, but also have proven to mislead patients, and undermine trust in our health care system. Robert F. Kennedy Jr., the incoming director of the Department of Health and Human Services, has called out these
deceptive tactics, highlighting their role in fueling the affordability crisis.
The Trump Administration previously sought to implement a rule addressing DTC advertising’s harmful effects by requiring ads to list the price of the drugs in advertising, but the rule stalled. Congress must pick up where this effort left off. Instead of enabling potentially manipulative practices, lawmakers should
prioritize holding drug companies accountable to truly deliver lower costs to the American people.
As Republicans work to improve our health care system, Congress must reject harmful policies like delinking, that de-incentivize pharmaceutical companies at the expense of seniors and taxpayers. The path forward requires protecting performance-based  incentives, resisting misleading advertising, and
championing reforms that prioritize affordability and access for all Americans.
Let’s ensure the incoming administration and Congress inherit a health care system poised for progress—not one burdened by the costly mistakes of the past.
Justin Reinig
Fort Wayne
260-704-0767