In an unexpected alliance, Donald Trump Jr. and billionaire entrepreneur Mark Cuban joined forces this week to criticize Sen. Elizabeth Warren (D-MA) for what they say is her failure to address one of the most entrenched and opaque drivers of high U.S. health care costs: pharmacy benefit managers, or PBMs.
The clash began when Warren posted on X (formerly Twitter), blaming “rigged” tax laws and accusing pharmaceutical giants like Johnson & Johnson of charging the highest drug prices globally while “often paying ZERO dollars in federal taxes.”
Cuban, who has long been an outspoken critic of the health care system—and of Donald Trump himself—quickly hit back, not against Big Pharma, but against the middlemen that control drug pricing behind the scenes.
Didn’t think I’d be RTing Mark for a while, but he’s 100% right on this issue. https://t.co/ofraK5IFQk
— Donald Trump Jr. (@DonaldJTrumpJr) June 19, 2025
“No. It’s because PBMs corrupt healthcare,” Cuban wrote. “Big Pharma wishes they could set their own pricing. They don’t. PBMs control formularies and manipulate prices, in exchange for providing pharma access to patients. It’s how they maximize rebate revenue.” He pointed out that just three PBMs are responsible for negotiating over 90% of all rebates for commercial insurance plans. “That’s your area of expertise, and you have done nothing,” he added, tagging Warren directly.
Enter Trump Jr., who, despite his ongoing feud with Cuban, backed him unreservedly. “Didn’t think I’d be RTing Mark for a while, but he’s 100% right on this issue,” he wrote, underscoring a rare bipartisan consensus on a complex health care pricing mechanism.
PBMs operate between drug manufacturers, insurance companies, and pharmacies. Critics, including the Federal Trade Commission (FTC), have argued that PBMs drive up prices by forcing manufacturers to pay steep rebates in exchange for placement on insurance formularies. The FTC’s recent findings accused PBMs of using contractual practices that disproportionately hurt smaller, independent pharmacies while favoring corporate chains like CVS, which owns one of the largest PBMs, Caremark Rx.
In Arkansas, these concerns prompted Republican Governor Sarah Huckabee Sanders to sign legislation banning PBMs from holding permits to distribute prescription drugs within the state. CVS, in response, threatened to shutter its Arkansas locations if forced to adjust its business model.
President Trump also took aim at PBMs during his administration and has continued the push into his second term. He signed an executive order promoting pricing transparency and encouraging direct consumer purchases to bypass PBMs entirely.
