In a fiery speech before the House Committee on Energy and Commerce on Wednesday, Rep. Alexandria Ocasio-Cortez (D-N.Y.) slammed the Republican Party for allowing Elon Musk to derail bipartisan drug pricing reforms, calling the move a clear example of oligarchic control over American politics.
The proposed reforms targeted pharmacy benefit managers (PBMs)—middlemen in the pharmaceutical industry who have been criticized for inflating prescription drug costs and driving small pharmacies out of business. While the legislation enjoyed near-unanimous support in Congress, it was abruptly dropped from the December budget bill after Musk publicly opposed it on social media.
Ocasio-Cortez directly linked Musk’s Twitter intervention to the bill’s sudden collapse, highlighting the billionaire’s outsized influence over Republican lawmakers and public policy.
Ocasio-Cortez detailed a timeline that showed how Musk’s opposition—posted online in the middle of the night—led to the bill’s rapid downfall.
“Republicans are in support, Democrats are in support — so what happened?” she asked during the hearing.
“Well, on December 15th, at 4:15 in the morning, Elon Musk began firing off a barrage of social media posts opposing pharmacy benefit manager reform,” Ocasio-Cortez said.
In the hours following Musk’s tweets, Republican leadership dropped the PBM reforms from the budget bill, even though lawmakers across the political spectrum had previously backed the measure.
“We had nearly 435 members on board with it—he sends one tweet, and all of a sudden, everyone backs off,” she continued. “And it kills drug pricing reform that would save people money on their insulin, on their asthma inhalers—everything that they need.”
What Are PBMs, and Why Do They Matter?
PBMs are powerful, largely unregulated entities that negotiate drug prices between pharmaceutical companies, insurers, and pharmacies. While they were originally designed to lower drug costs, they have been widely criticized for actually driving prices higher by prioritizing profits over patient care.
Federal regulators have scrutinized PBMs for years, finding that their opaque pricing practices inflate prescription costs for consumers and push independent pharmacies out of business.
Last year, lawmakers worked across party lines to develop a long-awaited reform package that would have placed tighter regulations on PBMs, increasing transparency and potentially lowering drug costs for millions of Americans.
However, despite broad support from patient advocates, healthcare experts, and even members of the GOP, the bill was blocked at the last minute—just hours after Musk complained about it on social media.
Ocasio-Cortez mocked Musk’s ignorance of the issue, pointing out that after his intervention derailed the bill, he admitted that he didn’t even know what a PBM was.
“And then, to kick it off, five days after he kills pharmacy benefit manager reform, we get this tweet from Elon Musk: ’What is a “pharmacy benefit manager?”’” she said.
The revelation underscored what Ocasio-Cortez described as a dangerous concentration of power in the hands of unelected billionaires—who, despite their lack of expertise, are now deciding major U.S. policy decisions.
Ocasio-Cortez warned that Musk’s ability to single-handedly sway congressional decisions represents a serious threat to democratic governance.
“The problem here isn’t a substance issue, it’s not a process issue—it’s an oligarchy issue,” she said.
“Whether you’re a Democrat or you’re a Republican, everyone here was elected to be accountable to the people of the United States—not to be governed by tweet, but to be governed by their duly elected representation.”
The lawmaker then challenged Republicans who had previously supported PBM reform to prove that they serve their constituents—not billionaires like Musk.
“So I would love a commitment from our Republican counterparts, who we agree with on this issue, to just put it on the floor. And let us vote for it,” she said. “And we can actually get a result for the American people by booting this guy out from political influence.”
While Musk publicly claimed he opposed the PBM reforms because the budget bill was too long and contained too much “pork,” critics argue that the move was really about protecting pharmaceutical industry profits.
PBMs operate at the intersection of Big Pharma, health insurers, and corporate lobbying, and any effort to reform their practices directly threatens the industry’s financial interests. By caving to Musk’s objections, Republicans ultimately protected a system that allows drug prices to remain high—at the expense of everyday Americans.
Despite the setback, the fight to regulate PBMs is far from over. Ocasio-Cortez’s call for a new vote on the reforms puts pressure on Republicans to explain whether they stand with patients or billionaires.
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