TrunpRX Lowers IVF Prices W/Out Mandates & Subsidies, FDA Greenlights Cheaper Biosimilars PBMs Won’t Choose, and UnitedHealth’s PBM Profit Precision Defies Basic Math

Hey all,

Happy Thursday! Well-intentioned policy runs headfirst into economic reality. New IVF access initiatives lack the mandates or subsidies needed to overcome cost barriers, FDA pathways for biosimilars won’t change PBMs choosing high-rebate options over low-cost alternatives, and drugmakers are selectively exiting government programs when discount demands conflict with their business models. Turns out you can create all the access pathways you want, but if the underlying incentive structure rewards expensive over affordable, the market will happily keep choosing expensive.

Enjoy the rundown!

Jacobrody (Co-Founder and CEO, ZorroRX) 

(BenefitsPRO) Trump Fertility Executive Order and IVF Access

President Trump’s executive order offering drug discounts for IVF and clarifying employer benefit options is unlikely to significantly improve access to fertility care, according to the Kaiser Family Foundation (KFF). Despite the high demand for fertility assistance, the order lacks mandates, subsidies, or tax incentives needed to drive widespread adoption or affordability—especially for those on Medicaid or without employer-provided benefits. But sure, the free market is really crushing it when off-patent fertility drugs still cost a fortune despite massive demand for cheaper generics. Full Article.

(STAT News) FDA Proposal on Biosimilars

The FDA unveiled a draft framework aimed at accelerating the approval of biosimilars—lower-cost alternatives to biologic drugs—by easing clinical requirements and cutting development timelines. This move, part of the Trump administration’s broader push to reduce drug prices, could increase competition in the high-cost biologics market and improve patient access. While this is very helpful, it still won’t change the economics around rebates and other mechanisms that have previously prevented adoption, since many pharmacy benefit managers (PBMs) are offered both a high-price, high-rebate biosimilar and a lower-cost one—and often choose the high-price option to leverage the rebate for subsidizing premiums. Full Article.

(Cost Curve) UnitedHealth’s PBM Profits & Bausch’s Exit from Medicaid/340B

UnitedHealth’s Optum Rx reported $1.544 billion in Q3 2025 profits—identical to the previous year’s figure—raising eyebrows over oddly consistent earnings as PBMs continue to generate substantial profits despite their claims of thin margins, while Bausch Health’s recent decision to exit Medicaid and the 340B program signals growing pushback from drugmakers against conflicting government demands for both steep discounts and lower drug prices. Of course, it’s easier to make a dramatic exit when your portfolio includes niche drugs like Retin-A and not, say, insulin—diabetes drugmakers won’t be ghosting Medicaid quite so casually. Full Article.