California Gov. Gavin Newsom is reviving efforts to regulate the powerful and often opaque intermediaries at the center of the prescription drug supply chain. In a proposal unveiled as part of his revised May budget, Newsom calls for stringent oversight of pharmacy benefit managers (PBMs), companies he says are driving up patient costs.

In less than a month, President Donald Trump has signed two major executive orders to overhaul the nation’s prescription drug pricing system. These orders have placed Pharmacy Benefit Managers (PBMs) at the center of the president’s ire and revived a controversial “Most Favored Nation” pricing policy that ties US drug prices to those abroad.

Pharmacy Benefit Managers (PBMs) have long operated in the shadows of the U.S. healthcare system, wielding significant influence over drug pricing and access. Recent developments, including federal investigations, state lawsuits, and bipartisan legislative efforts, have intensified scrutiny on these intermediaries, highlighting the urgent need for reform.