SUBSCRIBE TO OUR FREE NEWSLETTER
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
5
#000000
#FFFFFF
");background-position:center;background-size:19px 19px;background-repeat:no-repeat;background-color:var(--button-bg-color);padding:0;width:var(--form-elem-height);height:var(--form-elem-height);font-size:0;}:is(.js-newsletter-wrapper, .newsletter_bar.newsletter-wrapper) .widget__body:has(.response:not(:empty)) :is(.widget__headline, .widget__subheadline, #mc_embed_signup .mc-field-group, #mc_embed_signup input[type="submit"]){display:none;}:is(.grey_newsblock .newsletter-wrapper, .newsletter-wrapper) #mce-responses:has(.response:not(:empty)){grid-row:1 / -1;grid-column:1 / -1;}.newsletter-wrapper .widget__body > .snark-line:has(.response:not(:empty)){grid-column:1 / -1;}:is(.grey_newsblock .newsletter-wrapper, .newsletter-wrapper) :is(.newsletter-campaign:has(.response:not(:empty)), .newsletter-and-social:has(.response:not(:empty))){width:100%;}.newsletter-wrapper .newsletter_bar_col{display:flex;flex-wrap:wrap;justify-content:center;align-items:center;gap:8px 20px;margin:0 auto;}.newsletter-wrapper .newsletter_bar_col .text-element{display:flex;color:var(--shares-color);margin:0 !important;font-weight:400 !important;font-size:16px !important;}.newsletter-wrapper .newsletter_bar_col .whitebar_social{display:flex;gap:12px;width:auto;}.newsletter-wrapper .newsletter_bar_col a{margin:0;background-color:#0000;padding:0;width:32px;height:32px;}.newsletter-wrapper .social_icon:after{display:none;}.newsletter-wrapper .widget article:before, .newsletter-wrapper .widget article:after{display:none;}#sFollow_Block_0_0_2_0_0_0_1{margin:0;}#sSHARED_-_Social_Desktop_0_0_10_0_0_0.row-wrapper{margin:40px auto;}#sBoost_post_0_0_0_0_0_0_1_0{background-color:#000;color:#fff;}.boost-post{--article-direction:column;--min-height:none;--height:auto;--padding:24px;--titles-width:calc(100% - 84px);--image-fit:cover;--image-pos:right;--photo-caption-size:12px;--photo-caption-space:20px;--headline-size:23px;--headline-space:18px;--subheadline-size:13px;--text-size:12px;--oswald-font:"Oswald", Impact, "Franklin Gothic Bold", sans-serif;--cta-position:center;overflow:hidden;margin-bottom:0;--lora-font:"Lora", sans-serif !important;}.boost-post:not(:empty):has(.boost-post-article:not(:empty)){min-height:var(--min-height);}.boost-post *{box-sizing:border-box;float:none;}.boost-post .posts-custom .posts-wrapper:after{display:none !important;}.boost-post article:before, .boost-post article:after{display:none !important;}.boost-post article .row:before, .boost-post article .row:after{display:none !important;}.boost-post article .row .col:before, .boost-post article .row .col:after{display:none !important;}.boost-post .widget__body:before, .boost-post .widget__body:after{display:none !important;}.boost-post .photo-caption:after{content:"";width:100%;height:1px;background-color:#fff;}.boost-post .body:before, .boost-post .body:after{display:none !important;}.boost-post .body :before, .boost-post .body :after{display:none !important;}.boost-post__bottom{--article-direction:row;--titles-width:350px;--min-height:346px;--height:315px;--padding:24px 86px 24px 24px;--image-fit:contain;--image-pos:right;--headline-size:36px;--subheadline-size:15px;--text-size:12px;--cta-position:left;}.boost-post__sidebar:not(:empty):has(.boost-post-article:not(:empty)){margin-bottom:10px;}.boost-post__in-content:not(:empty):has(.boost-post-article:not(:empty)){margin-bottom:40px;}.boost-post__bottom:not(:empty):has(.boost-post-article:not(:empty)){margin-bottom:20px;}@media (min-width: 1024px){#sSHARED_-_Social_Desktop_0_0_10_0_0_0_1{padding-left:40px;}}.donation_banner{position:relative;background:#000;}.donation_banner .posts-custom *, .donation_banner .posts-custom :after, .donation_banner .posts-custom :before{margin:0;}.donation_banner .posts-custom .widget{position:absolute;inset:0;}.donation_banner__wrapper{position:relative;z-index:2;pointer-events:none;}.donation_banner .donate_btn{position:relative;z-index:2;}#sSHARED_-_Support_Block_0_0_13_0_0_3_1_0{color:#fff;}#sSHARED_-_Support_Block_0_0_13_0_0_3_1_1{font-weight:normal;}#sElement_Post_Layout_Press_Release__0_0_1_0_0_11{margin:100px 0;}.grey_newsblock .newsletter-wrapper, .newsletter-wrapper, .newsletter-wrapper.sidebar{background:linear-gradient(91deg, #005dc7 28%, #1d63b2 65%, #0353ae 85%);}.black_newsletter{background:linear-gradient(91deg, #005dc7 28%, #1d63b2 65%, #0353ae 85%);}.black_newsletter .newsletter_bar.newsletter-wrapper{background:none;}
To donate by check, phone, or other method, see our More Ways to Give page.
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
Today, Congressman Jamaal Bowman, Ed.D. (NY-16) introduced legislation titled the "Babies Over Billionaires Act" which would tax the unrealized capital gains of the top 0.01% of taxpayers with over $100 million in assets.
Today, Congressman Jamaal Bowman, Ed.D. (NY-16) introduced legislation titled the "Babies Over Billionaires Act" which would tax the unrealized capital gains of the top 0.01% of taxpayers with over $100 million in assets.
"Since the pandemic began, everyday people have borne the brunt of negative public health and economic outcomes. COVID-19 has taken nearly one million lives in the United States alone, forced people to decide between paying rent or buying food, and otherwise upended the livelihoods of millions, especially our youth," said Congressman Jamaal Bowman, Ed.D. (NY-16). "Meanwhile, American billionaires have shamelessly increased their collective wealth by more than $2 trillion. As a society it's time we center the people's needs who account for most of the American population, instead of roughly 700 billionaires who have swindled us all."
"Policy reflects our priorities, and for decades, the United States has chosen to invest in the personal wealth of billionaires while failing to invest in the tangible needs of our children and our communities. Working class people are taxed more than billionaires at times and often have their income more harshly scrutinized, all while struggling to keep up with the rising costs of basic needs like food and housing. At the same time, the tax code privileges billionaires who hide their wealth in an effort to avoid paying their fair share in taxes. The IRS also lacks the resources and capacity needed to audit and tax the ultra wealthy, while consistently auditing and taxing working families more. This bill would direct more resources towards the IRS to audit and tax people whose income requires more than reviewing just a W-2 or 1099 form, people like billionaires. By auditing and taxing the 700 richest people in our country the wealthy will finally pay their fair share. As a result more taxpayers funds would be made available for children-centered programs in the U.S. Department of Education and the U.S. Department of Health and Human Services. We must invest in our youth's future and critical social safety nets - the wealthy are more than capable of funding that effort!"
"Billionaires should pay their fair share of taxes - just like everyday workers, just like a grocery clerk, a teacher, a police officer, or a nurse," said Congressman Danny K. Davis (Il-7). "Equitable taxation is a critical step to providing much-needed federal investment to strengthen children and families."
"Billionaires and working families have had extremely different experiences in the last two years," said Congresswoman Susan Wild (PA-7). "This bill will address the inequities in our tax code that keep the ultra-wealthy from paying their fair share and will invest the revenue raised in those who deserve it most: our children and hardworking families."
"America has a two-tier tax system: one system for the millionaires and billionaires, and one system for everyone else. That unfair system is a primary driver of the economic divisions slowly tearing America apart," said Congressman Bill Pascrell (NJ-9), a senior member of the tax-writing House Ways and Means Committee and lead sponsor of legislation to close the infamous stepped-up basis and carried interest loopholes. "This legislation is another sharp tool to rebalance our unfair two-tier tax system and finally begin making those at the top pay their rightful share. Measures like this are essential to rebuilding public confidence in our nation. I thank Rep. Bowman for his aggressive work to make our tax system fair again."
It's time the tax code works for working families and not just wealthy people. The Babies Over Billionaires Act proposes income tax reform for the ultra-wealthy that would disproportionately impact the roughly 700 billionaires in the country to raise more than $1 trillion over ten years.
Specifically, the Babies Over Billionaires Act will:
* Annually tax 30% of unrealized gains of ultra-millionaires from publicly traded capital assets at the prevailing long-term capital gains rate;
* Tax 50% of unrealized gains of private capital assets at the prevailing long-term capital gains rate every 5 years;
* Mandate the IRS annually audit filers reporting in excess of $100 million in assets to crack down on rampant tax abuse by the wealthy.
* Invest the revenue raised by this tax in programs run by the Department of Education and HHS that support families and children.
Co-leads of the legislation include Representatives Bill Pascrell, Danny K. Davis, and Susan Wild.
Co-sponsors of the legislation include Representatives Eleanor Holmes Norton and Bonnie Watson Coleman.
Sponsoring organizations and people include: the American Federation of Teachers, Patriotic Millionaires, Economic Security Project Action, National Latino Farmers & Ranchers Trade Association, Progressive Change Campaign Committee, National Black Justice Coalition, Americans for Democratic Action (ADA), Coalition on Human Needs, MomsRising, Missionary Oblates of Mary Immaculate JPIC, People's Action, Jobs with Justice, RootsAction.org, Family Values @ Work Action, Public Citizen, National Asso. for Hispanic Elderly, Main Street Alliance, NETWORK Lobby for Catholic Social Justice, Family Values@Work, Institute on Taxation and Economic Policy, RESULTS, Oxfam America, National Coalition for the Homeless, Indivisible, MoveOn and American Federation of State, County & Municipal Employee
Click herefor a one-page summary of the Babies Over Billionaires Act.
Click here for a section-by-section of the Babies Over Billionaires Act.
Click here for full bill text of the Babies over Billionaires Act.
"The existing income tax is badly broken as applied to most billionaires and mega-millionaires, who are typically able to escape all tax on the majority of their true income or the returns to their invested wealth. This bill would fix the income tax by ending the ways in which billionaires and mega-millionaires currently escape tax. The bill uses an innovative phased mark-to-market methodology to spread out the taxation of investment gains over time so as to minimize valuation problems and volatility," said David Gamage, Law Professor at University of Indiana.
"Basic fairness and sound tax policy more broadly indicate that we need to do better at taxing the income of the extremely wealthy. This bill introduces two important innovations. First, the bill only taxes a portion of the capital gains of billionaires, which helps deal with fluctuations in asset value. Second, the bill taxes privately held assets, but less regularly than public assets. This will prevent gamesmanship between asset categories while also not imposing too great an administrative burden," said Darien Shanske, Law Professor at UC Davis.
"This legislation makes a simple yet profound statement: our tax system must start benefiting babies and their working parents, and stop coddling billionaires and their yachts. This bill will close one of the worst tax loopholes so that billionaires and other ultrarich people will be taxed annually on their investment gains--just like workers are taxed every year on their wages. Rep. Bowman's bill makes the tax system fairer while raising lots of needed revenue from the ones best able to supply it," said Frank Clemente, Executive Director, Americans for Tax Fairness.
"For too long, our tax system has made it possible for the super rich to extract wealth from white, Black and Brown working people, while not paying their fair share for the services we all use. This has created exploding white billionaire wealth and struggling Black and Brown working families. It's time we start using the tax code to build wealth for working people," said Mandla Deskins, Take on Wall Street at Americans for Financial Reform.
"Too many American families are struggling--living paycheck to paycheck or not making ends meet, particularly with rising costs, while doing their best to keep their loved ones healthy and helping their kids stay safe and engaged at school. The past two years have challenged us in so many ways, and the American family has stepped up each time. Yet at the same time, American billionaires are making a killing during COVID-19, managing to accumulate more than $1.7 trillion in new wealth during the pandemic and, in some cases, paying as little as nothing in federal taxes.
No one should be profiting off a pandemic while shirking their responsibilities to pay their fair share, especially at the expense of our youth. Rep. Jamaal Bowman's Babies Over Billionaires Act is just a commonsense rebalancing of the tax code by rewarding work instead of extreme wealth and prioritizing investments that benefit our nation's future generations," said Randi Weingarten, President of the American Federation of Teachers.
"While the country suffered during the COVID crisis, the wealth of the billionaire class surged by $2 trillion, and these wealth gains have gone largely untaxed. [Rep.] Bowman's bill addresses head-on this tax injustice by making sure billionaires pay their fair share and pay it timely. The proposed tax will raise more than $1T over the next 10 years solely from billionaires, making it possible to keep funding the expansion of the child tax credit that cut child poverty in half in 2021," said Emmanuel Saez, Economics Professor at UC Berkeley.
"While ordinary workers have to pay taxes year after year, billionaires can defer taxation for decades and sometimes forever. Congressman Bowman's bill is a common-sense solution to this unjustifiable situation," said Gabriel Zucman, Economics Professor at UC Berkeley.
"Our current tax code is ill-equipped to handle the realities of modern wealth. As a result, billionaire wealth in America has skyrocketed while many pay virtually no taxes. Their ability to choose when to pay taxes on their capital gains gives them an enormous advantage over people who pay taxes on every paycheck. It's time to require the richest people in this country to pay taxes every year just like Americans who work for a living. The Babies over Billionaires Act is exactly what this country needs - it would fix one of the fundamental injustices of our tax code and raise hundreds of billions of dollars while costing 99.9% of Americans nothing," said Morris Pearl, the Chair of the Patriotic Millionaires and a former managing director at BlackRock, Inc.
"Rep. Bowman's bill tackles the single biggest inequity in the tax code - the fact that billionaires often pay no tax at all as they accumulate their enormous wealth, while working people have taxes taken out of every paycheck. With President Biden's billionaire minimum tax proposal and this important new legislation, there is growing momentum to fix our broken tax code and plans on the table that are both bold and practical. Rep. Bowman and colleagues should be commended for confronting inequality head on and prioritizing children and families," said Seth Hanlon, Senior Fellow for Tax and Budget Policy at Center for American Progress.
Jamaal Anthony Bowman is an American politician and educator serving as the U.S. representative for New York's 16th congressional district since 2021.
(202) 225-2464"As a cease-fire in Gaza is near, Israel is expanding its assault on the West Bank," said one expert. "It was always a war on Palestinian existence."
As negotiators in Qatar navigated the "final stage" of a cease-fire agreement to end the U.S.-backed Israeli assault on the Gaza Strip, Israel's forces on Tuesday continued to kill Palestinians in the besieged coastal enclave and the illegally occupied West Bank.
Since the Hamas-led October 7, 2023 attack, the Israel Defense Forces (IDF) have killed at least 46,645 Palestinians in Gaza and wounded 110,012, with over 10,000 others missing, health officials said Tuesday. The true death toll could be much higher. A peer-reviewed analysis published last week in The Lancetfound that the official tally through last June was likely a 41% undercount.
The Palestinian National Authority's news agency WAFA reported Tuesday that IDF shelling killed at least two civilians at the Nuseirat refugee camp and a correspondent in Gaza City "said that Israeli warplanes fired missiles at a house in the Sheikh Radwan neighborhood, north of Gaza City, and another house in the Manara neighborhood, south of Khan Younis City, killing several civilians and injuring others."
According to multiple media outlets, Israeli forces also killed at least 13 people in an attack on a home in Deir al-Balah.
Israel faces a genocide case at the International Court of Justice over its assault on Gaza and in November the International Criminal Court issued arrest warrants for Israeli Prime Minister Benjamin Netanyahu and his former defense minister, Yoav Gallant, as well as Hamas leader Mohammed Diab Ibrahim Al-Masri.
In addition to waging war on Gaza over the past 15 months, Israel has stepped up its military activity in the West Bank—where a Tuesday strike on the Jenin refugee camp killed at least six Palestinians and wounded several others. The Times of Israelreported that "the IDF said it carried out the strike in a joint operation with the Shin Bet, without immediately providing further information."
The Israeli newspaper also noted that "on Tuesday evening, as on many previous Tuesday nights, thousands gather for a unity rally of prayer and song held in Tel Aviv's Hostages Square," while hundreds of right-wing demonstrators blocked "an intersection in central Jerusalem, in protest of the ongoing hostage negotiations between Israel and Hamas."
According to a draft obtained by The Associated Press, the first part of the three-stage deal would involve a halt to the fighting, both sides releasing captives, displaced Palestinians in Gaza returning home, and more humanitarian aid entering the strip.
Phase two would feature a declaration of "sustainable calm" and Hamas freeing more hostages in exchange for additional Palestinian prisoners and the full withdrawal of Israeli troops from Gaza, AP reported. The third part would include an exchange of bodies, a reconstruction plan for the strip—where civilian infrastructure is in ruins—and the reopening of border crossings.
"The terms of the deal being negotiated are largely consistent with what was on the table last May when outgoing President Joe Biden first announced it. Biden allowed Netanyahu to steamroll him for months—rewarding Israel with billions of dollars in arms transfers and political support after rejecting that cease-fire deal," Jeremy Scahill detailed at Drop Site News.
The latest cease-fire talks come as U.S. President-elect Donald Trump prepares for his inauguration next Monday. The Republican has been pushing for a resolution to Israel's assault on Gaza—or at least an appearance of one—before he returns to office.
"The fact that Trump emerged as the decisive player in pushing a potential cease-fire forward is evidence that Biden never used the full powers available to a sitting U.S. president to seal the deal in the summer," wrote Scahill. "While Trump has publicly repeated his threat that he will 'unleash hell' on Hamas if the Israeli hostages are not freed, his pressure has not been solely focused on Hamas; Trump and his aides have made clear to Netanyahu that the president-elect expects Israel to comply with his demands, too."
Netanyahu on Tuesday told hostages' families that "he is willing to agree to a prolonged cease-fire Gaza in exchange for their return," according toHaaretz. Later Tuesday, The Times of Israelreported that the prime minister was meeting with "Israel's hostage negotiation team and with members of Israel's security establishment," and expected negotiations to go through the night.
Even if a deal is reached regarding Gaza, some experts fear the bloodshed will continue there and in the West Bank
"There will possibly be an end to the Gaza war, but there will be now another war in the West Bank," Sami Al-Arian, a Palestinian analyst and director of the Center for Islam and Global Affairs at Istanbul Zaim University, told Scahill. "It may not be on the same scale, but it would be as vicious from the settlers, from the Netanyahu government."
Gazan writer and analyst Muhammad Shehada wrote for the U.S.-based Center for International Policy last week that a senior Arab official told him the U.S. president-elect asked the Qataris and Egyptians to finalize a deal before he takes office but the Israeli prime minister "is not budging while at the same time issuing false positive statements of a breakthrough and progress to buy time and pretend to seek a deal until Trump is in office, where Netanyahu can trade the Gaza war for something big in the West Bank."
Sharing on social media a video of the Tuesday strike on Jenin, Middle East expert Assal Rad said that "as a cease-fire in Gaza is near, Israel is expanding its assault on the West Bank. The Gaza genocide is only the most recent atrocity Israel—with the help of the U.S.—has carried out against Palestinians. The same story for 77+ years. It was always a war on Palestinian existence."
"Seriously? You wait until six days before leaving office to do what you promised to do during your 2020 campaign?" said one observer.
In a move likely to be reversed by the incoming Trump administration, President Joe Biden on Tuesday notified Congress of his intent to remove Cuba from the U.S. State Sponsors of Terrorism list, a designation that critics have long condemned as politically motivated and meritless.
Noting that "the government of Cuba has not provided any support for international terrorism" and has "provided assurances" that it will not do so in the future, the White House said in a memo that the Biden administration is moving to rescind the first Trump administration's January 2021 addition of Cuba to the State Sponsors of Terrorism (SSOT) list and take other measures to ease some sanctions on the long-suffering island of 11 million inhabitants.
Cuba's SSOT designation was based mostly on the socialist nation's harboring of leftist Colombian rebels and several U.S. fugitives from justice for alleged crimes committed decades ago, even though no other country has been placed on the SSOT list for such a reason and despite right-wing Cuban exile terrorists enjoying citizenship—and even heroic status—in the United States.
"Despite its limited nature, it is a decision in the right direction and in line with the sustained and firm demand of the government and people of Cuba, and with the broad, emphatic, and repeated call of many governments, especially Latin America and the Caribbean, of Cubans living abroad, political, religious and social organizations, and numerous political figures from the United States and other countries," the Cuban Ministry of Foreign Affairs said in a statement.
"It is important to note that the economic blockade and much of the dozen coercive measures that have been put into effect since 2017 remain in force to strengthen it, with full extraterritorial effect and in violation of international law and human rights of all Cubans," the ministry added.
For 32 straight years, the United Nations General Assembly has overwhelmingly voted for resolutions condemning the U.S. blockade of Cuba. And for 32 years, the United States, usually along with a small handful of countries, has opposed the measures. Last year's vote was 187-2, with Israel joining the U.S. in voting against the resolution.
Cuba followed Biden's move by announcing it would "gradually" release 553 political prisoners following negotiations with the Catholic Church, The New York Timesreported.
Many progressives welcomed Biden's shift. Congresswoman Nydia Velázquez (D-N.Y.) said in a statement that Cuba's SSOT designation "has only worsened life for the Cuban people without advancing U.S. interests" and "has made it harder for Cubans to access humanitarian aid, banking services, and the ability to travel abroad."
"It has also deepened food and medicine shortages and worsened the island's energy crisis, especially after Hurricane Rafael," she added. "These hardships have driven an unprecedented wave of migration, leading to the largest exodus in Cuba's history."
Rep. Ilhan Omar (D-Minn.) called Biden's move "a long overdue action that will help normalize relations with our neighbor."
"This is a step toward ending decades of failed policy that has only hurt Cuban families and strained diplomatic ties," Omar added. "Removing this designation will help the people of Cuba and create new opportunities for trade and cooperation between our nations. I look forward to continuing the work to build bridges between our countries and supporting policies that benefit both the American and Cuban people."
David Adler, the co-general coordinator at Progressive International, called the delisting "far too little, far too late."
"POTUS removing Cuba's SSOT designation in the final days of his presidency only means one thing: He knew—from day one—that the designation was simply an excuse to punish the Cuban people," Adler added. "But he maintained it anyway. Sickening."
The peace group CodePink released a statement welcoming Biden's shift, but adding that "it is unacceptable that it took this administration four years to address these injustices."
"President Biden made the inhumane decision every single day to not alleviate the suffering of millions of Cubans by keeping this designation in place," the group added. "As we mark this overdue progress, we can only hope that the Trump administration does not reverse these crucial steps towards justice and diplomacy."
Trump's nominee for secretary of state, Sen. Marco Rubio (R-Fla.) is the son of Cuban immigrants and a fierce critic of Cuba's socialist government. In 2021, Rubio introduced legislation aimed at blocking Cuba's removal from the SSOT list. Trump has also tapped Mauricio Claver-Carone—a staunch supporter of sanctioning Cuba—as his special envoy for Latin America.
Alex Main, director of international policy at the Center for Economic and Policy Research, said Tuesday that "while this decision, which comes years after 80 members of Congress urged Biden to reverse Trump's 'total pressure' approach should have been made long ago, it is better late than never."
"Sixty years of failed policy should be more than enough, and hopefully the new administration will have the wisdom and the courage to pursue a new course, one that's in the best interest of both the U.S. and the Cuban people," Main added.
Cuba was first placed on the SSOT list by the Reagan administration in 1982 amid an ongoing, decadeslong campaign of U.S.-backed exile terrorism, attempted subversion, failed assassination attempts, economic warfare, and covert operations large and small in a futile effort to overthrow the revolutionary government of longtime leader Fidel Castro. Cuba says U.S.-backed terrorism has killed or wounded more than 5,000 Cubans and cost its economy billions of dollars.
In stark contrast, Cuba has not committed any terrorism against the United States.
Former President Barack Obama removed Cuba from the SSOT in 2015 during a promising but ultimately short-lived rapprochement between the two countries that abruptly ended when Trump took office for the first time in 2017.
"Cuba will continue to confront and denounce this policy of economic war, the interference programs, and the disinformation and discredit operations financed each year with tens of millions of dollars from the United States federal budget," the Cuban Foreign Ministry said Tuesday. "It will also remain ready to develop a relationship of respect with that country, based on dialogue and noninterference in the internal affairs of both, despite differences."
Pharmacy benefit managers "are raking in billions in excess revenue—$7.3 billion over just five years—while squeezing independent pharmacies and leaving patients and health plan sponsors with skyrocketing costs."
The U.S. Federal Trade Commission on Tuesday published the second part of its investigation into how prescription drug middlemen are marking up the prices of specialty generic drugs dispensed at their affiliated pharmacies by hundreds—and in some cases, thousands—of percent, underscoring what advocates say is the need for urgent action by policymakers.
The FTC's second interim staff report on consolidated pharmacy benefit managers (PBMs) found that the three largest of these middlemen—CVS Health's Caremark Rx, Cigna Group's Express Scripts, and UnitedHealth Group's OptumRx—"marked up two specialty generic cancer drugs by thousands of percent and then paid their affiliated pharmacies hundreds of millions of dollars of dispensing revenue in excess of estimated acquisition costs for each drug annually."
"Of the specialty generic drugs analyzed in this report and dispensed by the 'Big Three' PBMs' affiliated pharmacies for commercial health plan members between 2020 and 2022, 63% were reimbursed at rates marked up by more than 100% over their estimated acquisition cost... while 22% were marked up by more than 1,000%," the report states.
"For the pulmonary hypertension drug tadalafil (generic Adcirca), for example, pharmacies purchased the drug at an average of $27 in 2022, yet the Big Three PBMs marked up the drug by $2,079 and paid their affiliated pharmacies $2,106, on average, for a 30-day supply of the medication on commercial claims," the publication notes. That's a staggering average markup of 7,736%.
"The FTC's second interim report lays bare the blatant profiteering by PBM giants."
"Such significant markups allowed the Big Three PBMs and their affiliated specialty pharmacies to generate more than $7.3 billion in revenue from dispensing drugs in excess of the drugs' estimated acquisition costs from 2017-22," the FTC said. "The Big Three PBMs netted such significant revenues all while patient, employer, and other healthcare plan sponsor payments for drugs steadily increased annually."
The new analysis follows a July 2024 report that revealed Big Three PBM-affiliated pharmacies received 68% of the dispensing revenue generated by specialty drugs in 2023, a 14% increase from 2016.
"The FTC staff's second interim report finds that the three major pharmacy benefit managers hiked costs for a wide range of lifesaving drugs, including medications to treat heart disease and cancer," FTC Chair Lina Khan said in a statement Tuesday. "The FTC should keep using its tools to investigate practices that may inflate drug costs, squeeze independent pharmacies, and deprive Americans of affordable, accessible healthcare—and should act swiftly to stop any illegal conduct."
Khan's time as chair is limited. Republican U.S. President-elect Donald Trump's inauguration is next week and he has named Andrew Ferguson as the next FTC chair. As Ferguson is already on the commission, his elevation to chair won't require Senate confirmation.
Greg Lopes, spokesperson for the Pharmaceutical Care Management Association, a PBM lobby group, said Tuesday that "it's clear this report again fails to consider the entirety of the prescription drug supply chain and makes sweeping assertions about the role of PBMs disconnected from a full appreciation of their critical cost-saving role for employers, unions, taxpayers, and patients."
Last September, the FTC sued the Big Three and their affiliated group purchasing organizations for allegedly "engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients' access to lower list price products, and shifted the cost of high insulin list prices to vulnerable patients."
FTC Office of Policy Planning Director Hannah Garden-Monheit said Tuesday that the problem of PBM price inflation "is growing at an alarming rate, which means there is an urgent need for policymakers to address it."
To that end, U.S. Sens. Maria Cantwell (D-Wash.) and Chuck Grassley (R-Iowa) introduced the Pharmacy Benefit Manager Transparency Act of 2023, a bill backed by the AARP aimed at increasing transparency and "holding PBMs accountable for deceptive and unfair practices that drive up prescription drug costs and force independent pharmacies out of business."
"This report is a call to action for policymakers to dismantle these exploitative schemes."
Responding to the FTC report, Emma Freer, senior policy analyst for healthcare at the American Economic Liberties Project—a corporate accountability and antitrust advocacy group—said in a statement Tuesday that "the FTC's second interim report lays bare the blatant profiteering by PBM giants, which are marking up lifesaving drugs like cancer, HIV, and multiple sclerosis treatments by thousands of percent and forcing patients to pay the price."
"By steering prescriptions for the most expensive specialty generic drugs to their own pharmacies, PBMs are raking in billions in excess revenue—$7.3 billion over just five years—while squeezing independent pharmacies and leaving patients and health plan sponsors with skyrocketing costs," Freer added. "This report is a call to action for policymakers to dismantle these exploitative schemes, outlaw the rebate system driving up prices, and restore fairness and affordability to the U.S. healthcare system."