The Unlikely Alliance That Just Declared War on Drug Middlemen

There's an old saying that politics makes strange bedfellows. In today's America, it's practically a miracle when two public figures, one from the MAGA right and the other from Shark Tank, manage to agree on anything without immediately accusing each other of treason.

This might be an example of "the enemy of my enemy is my friend."

When Donald Trump Jr. and Mark Cuban both lit their torches and turned them toward the pharmaceutical middlemen known as "pharmacy benefit managers," (PBMs), it wasn't just newsworthy. It was a red alert for the cartel that has quietly gripped drug pricing behind the scenes for years.

And make no mistake: These so-called pharmacy benefit managers aren't just faceless bureaucrats. They're profit brokers in lab coats, posing as patient advocates while playing gatekeeper with life-saving medications.

For once, left and right aren't arguing over who to blame. They've found the target, and it isn't who you thought.

Transparency Enters the Stage

You'd be forgiven for thinking drug manufacturers set the prices. After all, they invent the pills, right? You'd also be forgiven for thinking the market sets the cost of everything else in capitalism, right?

Wrong.

The price you pay is often padded, rigged, and twisted long after it leaves the factory. Who is to blame? The PBMs.

Cuban, who launched Cost Plus Drugs to sell generics directly to consumers, ripped the veil off the entire racket: PBMs are the ones deciding which drugs make it onto your insurance plan's formulary.

They negotiate so-called rebates, which are more like kickbacks, inflate the list price, and then skim from the top, middle, and bottom.

Want to know why your insulin doubled in price? Look no further than the office suites of CVS Caremark, Express Scripts, and OptumRx, the Big Three that control over 90 percent of the PBM market.

And Cuban's not guessing. He's living it. His entire business model exists because patients are tired of the shell game. Cost Plus doesn't deal with PBMs. It cuts them out. No secret rebates no backroom deals.

Just one price. Take it or leave it. For a tech billionaire, it's surprisingly populist.

For a patient, it's oxygen.

Bipartisan Bluster With Legislative Muscle

Now enter Don Jr., a man not known for cozying up to liberal billionaires. And yet when Cuban called out the PBM racket, Don Jr. echoed it like a war cry. "He's 100 percent right," Trump Jr. tweeted.

That one sentence did more than signal agreement. It cracked the narrative open.

For decades, Democrats blamed Big Pharma, while Republicans blamed regulation. Meanwhile, PBMs quietly made out like bandits, unregulated, unbothered, and unnoticed.

But not anymore.

With Don Jr. and Cuban on the same team, suddenly the PBMs look less like market innovators and more like union bosses from a Scorsese flick, controlling the docks, skimming the profits, and breaking kneecaps if you ask too many questions.

This is no longer just a consumer issue. It's a political thunderclap.

Arkansas has already passed legislation banning PBMs from owning or controlling pharmacies, and Gov. Sarah Huckabee Sanders made it clear: This happened because President Trump is back in charge.

Translation: The gloves are off.

The law's success in Arkansas is just the first domino to fall. Other red states are circling.

And some moderate Democrats, sensing the populist wind shift, may even jump aboard.

The Hidden Tolls of the Drug Highway

Imagine this: You're driving down a toll road. Every mile, there's a new gate. You pay five bucks at one, twelve at the next.

No signs explain the charges. No receipts are given.

And no one tells you where the money goes.

That's the U.S. prescription drug system.

Manufacturers make the pills. Pharmacies fill the bottles. Patients take the meds.

But PBMs own the road.

They decide the route. They set the tolls. And if you're lucky, you arrive at a pharmacy that actually stocks the drug your doctor prescribed, assuming it's still affordable by the time you get there.

Even worse?

These same PBMs are vertically integrated with major insurance providers. That means the people deciding your copay are often the same ones negotiating secret deals with manufacturers and quietly owning the pharmacies, too.

It's like letting the referee own one of the teams, sell the tickets, and charge the concession fees.

It's corruption dressed up in spreadsheets.

The Cost of Secrecy

The real scandal isn't just the price hikes. It's how well-hidden the entire process is.

The average American has no idea what a PBM is.

That's by design.

PBMs operate in the shadows, burying their rebate structures behind layers of legal jargon, contracts, and bureaucratic complexity.

And yet those hidden arrangements determine whether a cancer patient pays $50 or $5,000 a month. Whether a child gets his or her asthma inhaler or ends up in the ER. Whether a chronic pain sufferer gets access to treatment or is forced to go without.

These aren't hypotheticals. They're real choices being made by middlemen, not doctors. And often not patients, either.

That's what makes the Cuban/Trump Jr. moment matter. Because it forces the term "PBM" into the headlines. And once the public starts looking at the middle of the supply chain, the whole house of cards starts to shake.

The Revolt is Personal

Here's the gut punch: Americans don't care about PBM reform because it sounds like alphabet soup. We care because we feel it.

The elderly man rationing blood pressure pills.

The mother skipping her own meds so she can buy her son's antibiotics.

The chronic pain sufferer was getting by with one drug, but without warning, he was told he couldn't take it anymore.

The cancer survivor who finds out his drug was covered last year but not this year, for reasons no one can explain.

And when they ask why? The answers come in euphemisms. "Formulary exclusions." "Tiered pricing." "Coverage optimizations."

What they should say is: "Sorry. A guy in a tie five states away decided your drug was too cheap to make him rich."

What Happens Next

PBMs have been in the news several times in recent years. Each time, it starts with a bang, but slowly disappears with a whimper. This time might be different, because of who's talking about it.

With the spotlight finally on PBMs, here's what to watch:

1. Congressional rumblings: A bipartisan bill aimed at forcing PBMs to disclose rebate practices and pass savings to consumers is floating. The left wants transparency; the right wants free-market alternatives. For once, those goals intersect.
2. Corporate backlash: The Pharmaceutical Care Management Association (PBM lobby) is already suing Arkansas. Expect more lawsuits, PR blitzes, and op-eds warning that any interference could "destabilize" the system, which translates to messing with our money.
3. The next Cuban-style disruptor: Others may follow Cost Plus Drugs. Amazon flirted with the space. Walmart and Costco are already testing the waters. The question is, who can scale while avoiding capture by the very forces they're trying to upend?

Related: Pharmacy Deserts

Final Thoughts

The fact that Don Jr. and Mark Cuban are aligned on this issue is no small thing.

In a polarized America where we can't even agree on what day it is, this rare cross-aisle convergence exposes something more insidious than political games: a profit machine operating quietly in the middle, immune to scrutiny, and indifferent to suffering.

And here's the kicker, maybe the biggest one of all:

If these two men, who would probably wrestle each other for the last bottle of hot sauce in a debate greenroom, can agree that PBMs are strangling the system, then maybe we're finally seeing the start of a reckoning.

Not the kind with grand speeches or unicorn promises.

But the kind where people say: enough.

Strip away the suits, the contracts, the acronyms. What you're left with is this:

Too many people are going broke, going without, or going silent so a middleman can buy his third yacht.

And maybe, just maybe, that ends here.