What Trump's 'Great Healthcare Plan' means for drug costs and price transparency

• Key Insight: Here's why Trump's proposed "Great Healthcare Plan" redirects federal subsidies directly to eligible Americans.
• What's at Stake: Employers and employees facing rising premiums from complex pharmacy benefit manager financial arrangements.
• Expert Quote: "Transparency should be operational, not theoretical." — Kristin Begley, COO, Judi Health
  Source: Bullets generated by AI with editorial review.

A new healthcare proposal from President Trump has the potential to lower drug costs and increase price transparency — and leaders will have an important part to play. 

In January, the Trump administration introduced the framework for the "Great Healthcare Plan," which would call on Congress to lower prescription drug costs, shift federal insurance subsidies directly to consumers, and enforce strict price transparency. And while the bill could potentially make it a legal imperative to improve better disclosure, there will still be a significant need for the intervention of HR and benefit leaders to ensure that it actually works.

"The most precious asset you have as an employer is your people," said Kristin Begley, a licensed pharmacist and COO at health technology and benefit administration company Judi Health. "You need them at work and you need them healthy, and if healthcare is unaffordable because they can't cover the cost of the drugs that doesn't help keep people at work."

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Trump's "Great Healthcare Plan" is a proposed overhaul of the current healthcare system that would shift more control of healthcare spending from insurance companies to consumers. At its core, the plan would redirect certain federal healthcare subsidies directly to eligible Americans, potentially through health savings accounts (HSAs) or flexible spending accounts (FSAs), so people could use the money to purchase insurance or pay for medical expenses. That push to give consumers more control comes amid growing scrutiny of the complex web of companies that currently influence how healthcare dollars are spent, Begley said, particularly pharmacy benefit managers (PBMs). 

That focus on transparency is critically important in the current drug landscape, Begley said, where companies can own pharmacies and negotiate deals with drugmakers, creating financial incentives that may encourage higher spending. In some cases, PBMs could even favor certain drugs on their formularies because of those financial arrangements, even when they aren't necessarily the best option for patients. 

According to Begley, this has made the industry more complicated and created potential conflicts of interest because PBMs could make more money when patients and insurers spend more on drugs.

"As those costs get bigger, premiums go up because employers are spending more, which hurts employers' bottom line and employees' paychecks," Begley said. "All of this regulation is just to get more transparency, more accountability, and get a real price on these products."

Read more: How smaller businesses can keep their benefits cost-effective and competitive

Asking the right questions

In the meantime, Begley urged employers to closely examine how their PBM is compensated and whether it has financial incentives tied to higher drug costs, Begley said. That includes asking whether compensation is linked to drug prices, whether manufacturer rebates are fully passed through, whether there is spread pricing, and whether the PBM benefits financially from steering patients toward certain pharmacies or channels. Employers should also determine whether a PBM has built and negotiated its own pharmacy network or is simply using the network of a larger company, which the speaker says can obscure the same underlying financial incentives and economics.

Even when PBMs offer transparent contracts, they may use those agreements to offset less transparent deals where they make more money. As a result, a contract can appear transparent on the surface while still benefiting the PBM when drug costs increase. The speaker says employers should therefore look closely at whether their PBM's financial incentives are actually aligned with keeping costs down.

"Transparency should be operational, not theoretical," Begley said. "Claims-level visibility, rebate transparency, detailed financial reporting, audit rights, clear explanation — it isn't a marketing tactic. It's the ability to validate where every healthcare dollar went."

Leveraging tech tools to help

Begley argues that technology can make healthcare both more operationally efficient and easier for members to navigate by giving patients a single digital platform to understand their options, from finding high-quality doctors and affordable medications to accessing benefits and resolving claims. 

Read more: How to lift the burden of healthcare navigation off benefit leaders

At Judi Health, for example, the company built its own platform to replace outdated healthcare infrastructure and connect traditionally siloed systems, allowing clinicians, billing teams, account managers and call center representatives to work from the same information in plain language rather than navigating multiple legacy systems. 

The goal, Begley said, is to make service faster and more seamless while reducing administrative costs and improving the member experience.