Trump’s Tax Bill Targets PBMs, Exempts Orphan Drugs, Spurs Debate

Highlights

• The House passed President Trump’s “One Big Beautiful Bill Act” with a 215–214 vote, largely along party lines.
• The bill exempts certain orphan drugs from price negotiations under the Inflation Reduction Act, effective 2028.
• It prohibits PBMs from using spread pricing, a common but controversial practice.
• No changes were made to the “pill penalty” despite Trump’s prior executive support for its removal.
• The White House’s MAHA report critiques overmedication in children and highlights pharmaceutical industry influence.
• Recommendations include improved drug safety monitoring and further studies on long-term effects of pediatric medication.

House Narrowly Approves Sweeping Reform Bill

In a closely contested vote of 215–214, the U.S. House of Representatives on Thursday approved President Donald Trump’s expansive tax reform package, known as the “One Big Beautiful Bill Act.” The bill, largely supported along party lines, will now proceed to the Senate for further consideration. GuideView notes that "All Democrats and two Republicans voted against Trump’s tax bill."

Modifications to Drug Price Negotiations

The legislation proposes notable changes to drug pricing regulations established under the Biden administration's Inflation Reduction Act. A key adjustment is the exemption of certain orphan drugs—specifically, those approved to treat more than one rare disease—from federal price negotiations. These changes are slated to come into effect in 2028, pending Senate approval.

"Trump’s tax bill excludes orphan drugs approved to treat more than one rare disease from negotiations."

PBM Practices Under New Scrutiny

The bill also targets the controversial pricing practices of pharmacy benefit managers (PBMs). One significant provision prohibits spread pricing, a model in which PBMs charge payers such as Medicare more for medications than they reimburse to dispensing pharmacies—retaining the margin as profit.

"Trump’s One Big Beautiful Bill Act also puts some limits on pharmacy benefit managers, prohibiting a common practice called spread-pricing..."

“Pill Penalty” Exclusion Draws Attention

Notably absent from the bill is a correction to the so-called “pill penalty”—a disparity in the negotiation exclusion periods between small-molecule drugs and biologics. This omission is particularly striking given President Trump’s previous support for removing this penalty via executive order.

"Conspicuously missing from the act, however, are adjustments to the pill penalty..."

White House Publishes MAHA Report

On the same day, the White House released its nearly 70-page “MAHA” report—short for "Make America Healthy Again"—aimed at improving childhood health outcomes. The document serves as a policy roadmap for the Department of Health and Human Services, outlining a strategy to address what it terms the “childhood chronic disease crisis.”

"The report ‘provides [the] foundation’ for the Department’s mission ‘to make our children healthy again’..."

Criticism of Medical Overreach and Pharma Influence

The MAHA report criticizes what it calls the “overmedicalization” of children, pointing to excessive prescription practices and the influence of industry interests on regulatory bodies. It specifically cites the pharmaceutical industry’s lobbying expenditures from 1998 to 2018 as indicative of a broader issue of corporate influence.

"There is a concerning trend of overprescribing medications to children," the report reads, blaming this pattern on “conflicts of interest in medical research, regulation, and practice.”

Focus on Vaccine Safety and Drug Impact Studies

While acknowledging the protective benefits of immunization, the MAHA report also emphasizes the need for balanced evaluation of side effects, particularly with regard to the expanding childhood vaccine schedule. It proposes a stronger post-marketing surveillance system and calls for long-term studies on the neurodevelopmental and metabolic outcomes of commonly prescribed pediatric medications.

"The report recommends several initiatives, including launching a robust post-marketing surveillance mechanism for real-world safety findings..."