Skip to content

Elon Musk killed PBM reform without knowing what a PBM is

I was puttering around on something else when I ran across this:

Well, Elon, a pharmacy benefit manager is a company that handles negotiations with pharma companies on behalf of health insurers. Three big ones control almost the entire market and they supposedly bring down the cost of drugs through their collective buying power.

But they're also in the business of being maximally profitable, which doesn't always match up with saving consumers money. After years of PBM abuses being reported, in 2024 Congress was finally ready to do something:

Bipartisan lawmakers introduced a new bill on Tuesday that aims to crack down on the business practices of drug supply chain middlemen who are widely accused of inflating prescription medication prices and harming U.S. patients and pharmacies.

....Lawmakers and drugmakers alike argue that PBMs overcharge the plans they negotiate rebates for, underpay pharmacies and fail to pass on savings from those discounts to patients. Auchincloss said those practices have allowed PBMs to trap $300 billion in revenue in the middle of the drug supply chain between manufacturers and patients.

....Among the bill’s other efforts, it requires PBMs to share 80% of rebates with patients and prohibits several other practices. It would bar requiring patients to obtain branded medications when a cheaper generic version is available, steering patients to PBM-affiliated pharmacies and excluding any in-network pharmacy from filling a prescription, among other tactics.

Unfortunately, the bill failed to pass. You, Elon, should know this since you were the one who killed it. It was part of last month's Continuing Resolution that you mounted a jihad against, demanding that the CR should maintain current funding and absolutely nothing else.¹ This meant ditching PBM reform because it was 500 pages long and you insisted that page count was the proper metric for judging the bill.

So PBM reform died. And now you're telling us you never even knew what it was?

¹Except for hurricane relief, farm subsidies, the Key bridge, Virginia class subs, and pediatric cancer research.

37 thoughts on “Elon Musk killed PBM reform without knowing what a PBM is

  1. JohnH

    I want to believe this because it's outrageous, and that suits my hatred of him and the GOP. Still, I'd like to learn more. Can we confirm the media line that he killed a bill that otherwise had a strong bipartisan consensus behind it? Or is this just another example of the press wanting to think there are ethical compromising Republicans out there, even all over the place?

    Does the party really listen to him, beyond even what Trump pulls off? And has it ever NOT stood in the way of reform, indeed of anything a Democrat in office might want (and want to be credited with)?

    1. AnotherKevin

      We all watched it happen in real time, very recently. The bipartisan bill was put forward by Johnson himself. Then Musk went ballistic on Twitter etc., and the Republicans chickened out and pulled the bill.

      1. AnotherKevin

        And one of his stupid talking points was the number of pages in the bill - which anyone with even half a brain knows is not a remotely relevant metric for evaluating the merits of a bill.

  2. akapneogy

    Musk is on the right track. But is he smart/honest enough to acknowledge that for profit health care does not work?

    1. J. Frank Parnell

      Musk follows a simple cost cutting policy with his businesses: fire everyone and then hire them back as necessary to put out the resultant fires. Doesn't strike me as an approach that will work well with health care.

      1. Austin

        Doesn’t really strike me as a policy that would work well with any business. Usually hiring people back that you already fired costs you more - I certainly would demand more to return to an employer who fired me, especially if I could see that the employer has active fires needing to be put out. That’s the kind of situation that leads to people asking for double or triple their prior salary.

    2. Salamander

      Sure it does! Lots of profits, all the way down the line, for whole chains of middlemen! They've been able to wring TWICE as much money per capita out of the American public as happens in the civilized nations!

      ... Oh, did you mean something different by "work"?

    3. cephalopod

      What is this "right track" you think he is on? Because what he actually did was kill a bill with useful reforms because he is too lazy to learn what was actually in the bill.

  3. raoul

    Criticism of legislative bills based on page count is so stupid specially now that we don’t have the Chevron deference. Republicans really play the game of you are doomed no matter what Dems do. Get the executive out interpreting laws is bad, get the legislative to spell out what the laws are is bad too. What a way to run a country.

  4. kenalovell

    It's impossible to believe Musk can't use a search engine, so why would he ask Twitter an obviously dumb question that reveals his ignorance? Was it a snide way of suggesting there's really no such thing as a "pharmacy benefit manager" and he was looking forward to people offering confused, contradictory answers to his zinger question?

    The man constantly behaves like an immature troll. It's like watching one of those Hollywood movies where a kid swaps bodies with a grown-up. Any government which isn't eliminating dependence on his companies as quickly as possible is nuts.

    1. J. Frank Parnell

      Speaking of kids in adult bodies, did you know you can program your Tesla to make farting sounds? Elon evidently considers it hilarious.

    2. TheMelancholyDonkey

      Musk wasn't signaling ignorance, though his audience does celebrate it. He was signaling total indifference, which his audience celebrates even more. Always make it clear that you don't care about anyone but yourself.

    3. Leo1008

      @kenalovell:

      This is a good question:

      “It’s impossible to believe Musk can't use a search engine, so why would he ask Twitter an obviously dumb question that reveals his ignorance?”

      But that sort of thing has been going on for quite a while now, and the incident that Kevin is discussing is hardly the first (or even the hundredth) example.

      Ultimately, with people like Musk, there’s no point looking for logic or rationality. If we can’t understand them, that’s probably a good sign (it indicates we are still grounded in reality).

      The genuinely strange experience that modern America has been going through for a decade, first with Trump and now with Musk, is that we’ve been seeing what happens when clearly unwell individuals suffering from obvious and severe personality disorders assume prominent and powerful positions in society.

      Trump, as best I can tell, exhibits traits of both antisocial (or sociopathic) and narcissistic disorders. And that’s a uniquely toxic combination. But, I hasten to add, it does not mean that he’s insane. There’s a fine line. He has not had a psychotic break with reality (along the lines of schizophrenia), but he is very obviously delusional.

      In the case of Musk, I suspect something different: a borderline personality disorder. People like that lack the ability, or insight, into just how inappropriate their unregulated behavior really is. And they cannot be corrected. They just will not accept fault or blame. It’s like asking a blind man to look at himself in a mirror.

      And I would add that there are millions of families out there who are stuck dealing with relatives who exhibit the same problems. Obama made a passing reference to this point in a campaign speech when he said that, if Trump were in your family, you first of all would not trust him with anything and, secondly, you’d get him some kind of therapy.

      But Trump and Musk have now brought the experience of intense personality disorders to the national stage. And we all get to suffer as a result. We can only hope things work out no worse than Trump’s first term.

  5. drickard1967

    Any chance this will dissuade Kevin of his belief that Elon *must* be smart because of how rich and famous he is?

  6. iamr4man

    I keep expecting a British secret service agent to throw him into a pool of piranhas or down a smokestack or something like that.

  7. D_Ohrk_E1

    You didn't actually believe Musk had any iota of knowledge to be able to delve into policy. It's not like he's ever spent half his life thinking about policy on a variety of wide-ranging issues.

  8. DFPaul

    Never seen one of those newfangled bar code readers before... "Hey, that guy should be deciding if the government is running properly!" 😉

  9. chumpchaser

    If you ask anyone knowledgable in any field Musk talks about, you find out that he's actually a moron, like in that Knives Out movie. He's a fraud, but stupid people think tech buzzwords are the sign of a genius. It's not. He's not an inventor of anything. He just takes credit for shit other people do. He's a parasite. And now that we get to see inside his brain a bit, we can all witness how fucking stupid he is. Anyone who is surprised ought to ask themselves which media outlets led them to be this gullible.

    1. iamr4man

      This quote was posted by Digby, and I think it illustrates your point:

      There are certainly other factors at play, but heavy use of c-sections allows for a larger brain, as brain size has historically been limited by birth canal diameter
      Elon Musk

  10. OldFlyer

    It was doomed anyway. Come January Big Pharma will advised T they purchased $X Mil worth of ads on Truth Social. End of reform.

    K-St rules

  11. Altoid

    At the moment it happens I'm reading Character Limit, about Elmo's song-and-dance around buying Twitter and what he did when he took over.

    It shows convincingly that he's a near-complete fraud who knows next to nothing about how complicated processes and organizations work and interact internally and with external contexts, no regard for how organizations function and what they need in order to function, and a disregard for people around him so deep he's simply not fit to be responsible for other human beings.

    He's a fraud even at what he says is a core of his own identity, coding -- he rated Twitter programmers on *how many lines of code they'd written*. Anybody who's done the least bit of it knows that longer code is often, if not likely, worse code, and that programming is about esthetics and efficiency at least as much as it is about volume. Also too it's a complete 180 from his supposed beef against the CR, but never mind that.

    What he really looks like is a mean and crab-souled human being who read Tracy Kidder's _Soul of a New Machine_ as a management how-to instead of an expose. The worst thing that happened to him was getting the billions, and the worst thing he does is inflict himself on everybody else.

    And now trump is inflicting him on all of us, for as along as this mutual infatuation lasts. I really can't wait for the moment Elmo tries to throw trump over the side. It can't come too soon for my taste.

  12. jdubs

    When you look past the fake myth of Elon stories that Elon created about himself and look past the fawning coverage he has received from the press pretending he is Ironman, you see that he's been an idiot all of his life. This isn't an act or a recent change. He's always been this moron.

  13. gibba-mang

    I've worked in the health insurance space for the past 15 years an knew little about PBMs. I've learned a lot from Mark Cuban's writings on BlueSky recently

Comments are closed.