Accounts that enhance the regulation pending in both blue and red situations

The tide of populism has increased to the extent that a vocal minority of policies and kinds of GOP have begun to sound more like rep. Some issues. Get Republicans at Capitol Hill and Trump’s administration reported in recent weeks, expressing the opening to increase the top income tax rate on upper income households.

“It sounds like Bernie Sanders Economics,” said Steve Moore, chairman of the Commission to liberate prosperity and former Wall Street editorial council member, who was appointed President Donald Trump for the Federal Reserve Council during his first term of office for his first term of office. For some taxpayers. Meanwhile, Steve Bannon, a former Trump adviser, who is now calling on Republicans to increase federal income tax rates for higher incomes, claim to be exactly the point. According to Bannon, it would be politically genius for Republicans to agree with the progressive argument that higher income taxpayers should pay higher tax rates, although today they have a disproportionate share of the federal tax tax tax.

Washington is not the only place where policy proposals expanding to the government seem to win some GOP support. The same phenomenon occurs in some state areas.

Consider, for example, the legislation on extensive producer responsibility (EPR) now in books in five blue states. EPR legislation establishes a state regulatory regime through which the consumer goods fees are evaluated according to the amount of plastic packaging they use. The first EPR bill was established in 2021 in Maine. Since then, EPR has been approved in Oregon, California, Colorado and Minnesota. The number of states by EPR law on plastic packaging could soon be increased from five to seven, depending on the actions taken by two democratic rulers, one of which is considered a presidential perspective of 2026.

On April 7, legislators in Maryland, where the Democrats control the state’s legislative body, voted for an EPR bill, which is now in the office of Wes Moore (D). Washington state legislators recently voted for EPR’s legislation, which is in the office of Governor Bob Ferguson (D) that awaits his estimation.

However, in 2025, legislators in democratic states have begun to be more interested in EPR. In Tennessee, for example, a Republican Senator introduced an EPR bill into a state legislation where the GOP has over -election to both Chambers. This bill did not pass, but it is worth noting that a new policy trend coming from Bluest States-one that includes the imposition of a new regulatory regime that increases costs-even in deep red states.

Proposals for further PBM arrangements and imposing new pharmacy taxes introduced in nearly 20 states

In addition to the EPR, there are other areas where legislation increases the state regulation of certain products, services and business models that gain attraction in both blue and red states. Take House bill 163The legislation introduced this year to the North Carolina General Assembly, which seeks to further regulate PBMS (PBMS) managers, requiring greater revelation for a practice known as “successive pricing”, as well as adding what is equivalent to a new tax. First, it is useful to first provide a background for “successive pricing”, along with state efforts to regulate and even prohibit it.

“Almost every state has passed some form of PBM regulations in recent years”, ” notes The National Association of Community Pharmaceuticals. So far, 16 states have laws that prohibit the spread of pricing. Last year, according to Multistate, “33 accounts were established in 20 states related to the regulation of pharmacy benefits”, a trend This continued in 2025.

Mississippi’s legislators recently rejected a bill seeking to regulate the dissemination of North Carolina’s HB 163. In an article on this proposal, Russ Latino, editor of The Magnolia Tribune; does a thorough job of the explanation of a complex system, starting with the collapse of the basic categories of stakeholders:

What are the players in the pharmaceutical industry and what is the role they play?

· Third party providers: They include private health insurance companies, government payers such as Medicare and Medicaid, as well as private employers who self -funding their own health insurance plans for employees (sometimes called ERIISA plans). Third -party payers cover a significant part of the prescriptions sold in the US in exchange for premiums paid by employers, employees and individuals or through programs funded by taxpayers.

· PBMS: When insurance companies began to cover prescription drugs in the 1960s, PBMS were created to negotiate with medicines and pharmacies on their behalf.

PBMs use their collective purchasing power to earn prices reductions from drug companies, which are transferred to third parties and ultimately to patients. PBMS also makes recommendations to cover drugs (referred to as a type list) to encourage the use of what they consider to be the most effective, most affordable medicines.

The other key players described by Latino include wholesale distributors and Pharmaceutical Distributors (PSAOS). While pharmaceutical manufacturers determine the initial drug prices, they usually do not sell directly to pharmacies today, which largely supply their stock from wholesalers.

“Large pharmaceutical chains are negotiating their own conventions for PBM refund,” Latino explains. “Because they buy larger drug volumes, they have more leverage negotiation. Independent pharmacies keep PSAOS to negotiate on their behalf and conclude contracts with PBM.”

In addition to providing a comprehensive overview of basic stakeholders, Latino also offers a useful primer for the flow of money through the system:

· Drug purchase: Pharmacies buy medicines directly from wholesalers. The price paid by pharmacies is traded on the basis of volume.

· Return: When a pharmacy fills a prescription, either paid directly by the consumer or returned by a third payer, often with a “co-pay” consumer. The rate of compensation depends on the contract between the PBM of the third party and the pharmacy (or the PSAO traded on behalf of independent pharmacies).

· Discounts: wholesale distributors offer discounts on pharmacies, which are often associated with generic drugs. Medicines manufacturers provide discounts on PBMS, which play an important role in the decision that payers will cover by third parties from the medicines and the percentage by which they will offer a refund. 91 percent of these discounts are transferred to third parties. This helps to reduce the cost of health insurance to employees for employers.

· Invoice spreads: This is the difference in the percentage that a third payer agrees to pay for a prescription and the interest rate negotiating between PBM and the pharmacy or PBM and PSAO.

As Latino explains, successive pricing “has been controversial in the biggest national debate on PBMS”. While PBMs have become a popular political objective, if they did not provide any form of value, they would not exist. Third -party payers, such as employers, choose pricing options because they create certainty and reduce their own risk. If a pharmacy charges more for a drug than the employer has agreed, the employer pays the lowest cost and the PBM gets the loss.

As shown by Latino’s useful distribution, this is a complex issue. That is why it is for legislators who are considering the proposals aimed at PBM, such as HB 163, not to believe myopic, but rather in terms of what is good for the whole ecosystem of health care and the wider economy. “

In this Magnolia Tribune The track, Latino continues to point out the events that can lead to some to call into question why PBMs are abused and legislated. “In the midst of allegations of ‘excess’, the best measurement would be to examine the net profit margin,” Latino points out. “According to the Brookings Institute on the left, the average net profit margin for PBMS is 4%. To put it in this context, the company’s net profit margin mixture in S&P 500 in the 4th quarter of 2024 was 12.1%. “

“The National Association of Pharmacists of the Community 21%“Latino pointed out in comparison. All this helps to explain why Brookings concluded that even if the government banned the PBM from gaining,” it would have a negligible effect on drug prices “.

Critics of HB 163, such as North Carolina’s health care coalition (AHC), also point out the imposition of a new pharmacy tax as a key defect that “will increase the cost by billions over the next decade”. Similar pharmacy tax proposals have been introduced this year in 18 states.

“This tax would be an unexpected for large pharmacy chains but does not provide any additional benefit to the consumer”, AHC were explained In a blog post, which also criticized the fact that HB 163 “eliminates an optional tool that many businesses use to predict prices on prescription medicines”.

“Removing options on how businesses can design better and pay for their employee’s recipes is not a reform that will help anyone,” AHC added. When a similar proposal was examined in Mississippi, Latino informed that “attention is the right temperament” to approach such issues, noting that it is well documented how “national and state efforts to regulate the healthcare market have been added to a cumulative system”. It will soon be well known whether most North Carolina legislators agree with this feeling.

North Carolina’s home has scheduled HB 163 to take over the floor on Tuesday, April 29. If the body does not approve HB 163 by May 8, the bill dies. Regardless of the result with HB 163, its progress is one of the many recent examples that prove that the accounts that enhance the regulation can attract interest in the blue states, as well as those where GOP has legislative arrogance.