PBM Reform: Championing the Issue Publicly While Staying Silent When Trump Kills It—Repeatedly

Why This Matters for NY-23

Rural NY-23 has lost multiple independent pharmacies, forcing residents to drive 30+ miles for prescriptions. PBM reform would directly address the pricing practices that make rural pharmacies unprofitable. When Langworthy publicly champions this reform but stays silent each time Trump kills it, the pharmacies keep closing — and constituents don’t know why the “urgent” reform never passes.

Statement

Source: Press Releases, Floor Speech, Wellsville Sun Interview Reported by: Wellsville Sun, Langworthy.house.gov

December 17, 2025: “This package was ready to go last Christmas, but it was stripped out at the last minute. A full year has gone by, and the consequences of inaction are now impossible to ignore. We have to act—and we have to act now.”

Langworthy has positioned himself as a leading advocate for Pharmacy Benefit Manager reform, calling pharmacy closures “a healthcare emergency” for rural communities.

The Pattern: Public Advocacy, Private Silence

What Langworthy says: PBM reform is urgent and he’s fighting for it.

What the record shows: Reform has been stripped from legislation three times at Trump’s direction. Langworthy remained silent each time, only becoming vocal again after Trump launched his own branded initiative.

Timeline

December 2024: First Removal

December 8, 2024 — Trump backs PBM reform at Mar-a-Lago

• Trump publicly affirms commitment to PBM reform
• Source: NACDS

December 2024 — American Relief Act stripped of PBM reforms

• Telehealth and PBM reforms removed from spending bill at behest of Trump and Elon Musk
• Pharmacists and advocates express dismay at last-minute removal
• Source: News From The States

December 20, 2024 — Langworthy’s press release (actual text):

“Today, I proudly voted to pass the American Relief Act, standing with President Trump to keep our government open, ensure our Troops continue receiving their paychecks, support our hardworking and financially strained farmers, and provide disaster relief to communities devastated by hurricanes.

I remain committed to expanding access to telehealth services and pursuing much-needed reforms to hold Pharmacy Benefit Managers accountable, ensuring lower prescription drug costs for all Americans.”

What the press release reveals:

• Langworthy acknowledges telehealth and PBM reform as priorities
• Uses future tense (“remain committed to…pursuing”) — because the reforms were no longer in the bill
• Does not tell constituents that Trump/Musk had these reforms stripped
• Creates impression he’s fighting for these issues while voting for a bill without them
• Source: Langworthy Press Release

May-July 2025: Second Removal

May 12, 2025 — Trump touts PBM reform again

• Trump issues executive order targeting “drug pricing middlemen”
• Source: IVN

May 22, 2025 — H.R. 1 (OBBB) passes House WITH PBM transparency provisions

• PBM reform included in House version of One Big Beautiful Bill
• Bill goes to Senate

July 1, 2025 — Senate strips PBM reform from OBBB

• GOP-led Senate, in coordination with Trump, removes PBM provisions before sending bill back to House
• Brownstein Hyatt law firm confirmed: “Although included in the House version, notably absent from the final reconciliation bill were provisions to modernize and ensure pharmacy benefit manager (PBM) accountability, as well as prevent the use of spread pricing in Medicaid.”
• Applied Policy confirmed: “The PBM reform language from the House-passed bill was not included in the final version.”
• Sources: Healthcare Finance News, Brownstein, Applied Policy

July 2, 2025 — Langworthy’s floor speech (actual text):

“In just a short time, key provisions of the current tax code—provisions that helped power economic growth, create jobs, and lift take-home pay for millions of Americans— are set to expire.

If we do nothing, we’re looking at the largest tax increase in a generation. Families will see their child tax credit slashed. Small businesses will lose vital expensing tools… Workers will see their paychecks shrink…

That’s why the legislation before us today makes the Tax Cuts and Jobs Act permanent, and brings historic tax relief to seniors, tipped workers, and those who work overtime.”

What the floor speech reveals:

• Entire speech focused on tax provisions
• Zero mention of PBM reform being stripped from the bill
• Zero mention of healthcare at all
• Does not inform constituents that a provision he called essential was removed
• Source: YouTube - Floor Speech, Langworthy Press Release

July-September 2025: Langworthy Waits for Trump’s Signal

July 10, 2025 — PBM Reform Act introduced

• Rep. Buddy Carter (R-GA) introduces H.R. 4317, the PBM Reform Act
• 11 bipartisan cosponsors sign on
• Langworthy is NOT among them
• Trump makes no comment on the bill
• Source: Congress.gov

September 30, 2025 — Trump launches “TrumpRx”

• Trump announces branded prescription drug initiative
• Same day: Langworthy becomes cosponsor of PBM Reform Act
• Source: Congress.gov cosponsors list

December 2025: Langworthy Returns to Vocal Advocacy

December 17, 2025 — Wellsville Sun interview

• Langworthy expresses “great urgency” to pass PBM reform
• Claims “this package was ready to go last Christmas”
• Does not mention that it was Trump who had it removed—twice
• Source: Wellsville Sun

Additional Context: What OBBB Actually Does to Drug Pricing

What the final law DOES include (Section 71203): The One Big Beautiful Bill that Langworthy championed includes Section 71203, which expands exclusions from Medicare drug price negotiation — making it harder for Medicare to negotiate drug prices, not easier.

Specifically, it:

• Expands the orphan drug exclusion from the Drug Price Negotiation Program
• Allows drugs approved for “one or more rare diseases” (rather than “only one”) to be excluded from negotiation
• Creates new exclusions for “former orphan drugs”
• Takes effect for drugs selected for negotiation starting January 1, 2028

What was REMOVED from the final law:

• PBM accountability and transparency provisions
• Prohibition on spread pricing in Medicaid
• Provisions to “modernize” PBM oversight

The net effect: The law Langworthy voted for makes Medicare drug negotiation narrower while removing PBM reforms that would have addressed the pricing “crisis” he describes.

Langworthy has not publicly addressed this contradiction while promoting PBM reform as the solution to drug pricing.

The MAHA Caucus Contradiction

December 30, 2024 — Ten days after voting for a bill stripped of PBM reform, Langworthy announced he was a founding member of the “Make America Healthy Again” (MAHA) Caucus.

His press release stated:

“Healthy food and access to quality medical care are essential for the long-term health of our communities… This Caucus will not only help ensure every community has better access to healthy food options but also affordable, quality healthcare so families can focus on living well and building strong futures.”

The caucus claims to address “rising rates of chronic diseases” and support “underserved and rural communities.”

The contradiction: Langworthy joined a caucus focused on “affordable healthcare” immediately after voting for a bill that:

• Had PBM reform stripped out (raising drug costs)
• Cut $911 billion from Medicaid (reducing healthcare access)
• Let ACA subsidies expire (raising premiums for 6,300+ NY-23 residents)

Source: Langworthy Press Release

The Pattern

Visual Timeline

When Trump supports reform: Langworthy is vocal. When Trump kills reform: Langworthy is silent. When Trump launches branded initiative: Langworthy suddenly cosponsors.

In Plain Language

PBM reform has been stripped from legislation three times — each time at Trump’s direction. Here’s the pattern:

1. Trump publicly supports reform → Langworthy makes supportive statements
2. Trump privately kills reform → Langworthy says nothing
3. Repeat

When a standalone PBM reform bill was introduced in July 2025, Langworthy didn’t cosponsor it for 82 days — until the exact day Trump launched “TrumpRx.” He’s not advocating for rural pharmacies; he’s waiting for permission.

Questions This Raises

1. Why did Langworthy not mention PBM reform being stripped when praising the American Relief Act in December 2024?

2. Why did Langworthy not mention PBM reform being stripped when praising OBBB in July 2025?

3. Why did Langworthy wait 82 days to cosponsor the PBM Reform Act—until the same day Trump launched TrumpRx?

4. If PBM reform is the urgent “healthcare emergency” Langworthy describes, why has he remained silent each time Trump killed it?

Sources

• NACDS: “President-Elect Trump Affirms Commitment to PBM Reform” (December 8, 2024)
• News From The States: “Pharmacists bemoan loss of prescription drug middleman reforms” (December 2024)
• Langworthy.house.gov: “Congressman Langworthy Votes to Pass American Relief Act” (December 2024)
• IVN: “Pharmacy Benefit Managers and Trump’s Executive Order” (May 12, 2025)
• Healthcare Finance News: “Senate removes PBM provision from tax and spending bill” (July 2025)
• Brownstein Hyatt Farber Schreck: “Final Health Care Provisions in the One Big Beautiful Bill Act” (July 9, 2025)
• Applied Policy: “One Big Beautiful Bill Act Signed into Law” (July 29, 2025)
• Mintz: “PBM Policy and Legislative Update — Summer/Fall 2025” (November 2025)
• Public Law 119-21: One Big Beautiful Bill Act, Section 71203 (July 4, 2025)
• YouTube: Langworthy Floor Speech on H.R. 1 (July 2, 2025)
• Congress.gov: H.R. 4317 Cosponsors List
• Wellsville Sun: “Langworthy Urges House Leadership to Act Now on Comprehensive Pharmacy Reform” (December 17, 2025)

Research contribution: Kathleen [Last Name]

Note: This entry documents publicly available information from congressional records, news reports, and official press releases. Readers may draw their own conclusions.

Last updated: December 29, 2025