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The pharmaceutical industry is under mounting government scrutiny because of rapidly increasing expenditures for drugs in the United States. Drug expenditures are now the fastest-growing component of U.S. healthcare costs, increasing at an unsustainable rate of about 15 per cent per year. In fact, it is now estimated that total prescription drug spending comprises anywhere between 10-15% of the $3.3 trillion price tag for total U.S. healthcare expenditures. With pressure mounting both from policy initiatives being advanced by the Trump Administration including a controversial drug price control plan along with a strong legislative push starting in 2019 by the\Democratic majority in the House, understanding how this is most likely to unfold in the months ahead will help determine the future impact of federal policy on prescription drug pricing in 2020 and leading up to the the national election next November. Depending on the outcome of these policy efforts, potentially billions of dollars are at risk for both drug manufacturers and middlemen such as pharmacy benefit managers.