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For a moment, it looked like Congress would actually pass reforms to controversial pharmacy benefit managers after several years of introducing bills and holding hearings.

But it wasn’t meant to be. The list of measures that would have brought more transparency to the industry and changed some of its practices were removed from the administration’s massive bipartisan funding package, which was torpedoed by President-elect Donald Trump and billionaire Elon Musk on Wednesday.

The final, greatly slimmed-down law preventing the federal government shutdown was signed by President Joe Biden on Saturday.

However, efforts to overhaul the PBM industry will likely continue next year. Trump recently criticized the industry at a news conference at Mar-a-Lago after saying Americans are paying too much for drugs.

“We have something like the middleman. “You know the middleman, right?” Trump said at his Florida estate. “The terrible middleman who honestly makes more money than the drug companies, and they do nothing but be a middleman. We’re going to cut out the middleman.”

Pharmacy benefit managers act as intermediaries between drug manufacturers and insurers, employers and governments. They negotiate discounts from pharmaceutical companies, determine which medications are covered by insurance companies, and pay pharmacies. But they have drawn the ire of Congress and others with their opaque practices.

The now-collapsed funding deal would have required PBMs to provide more information about the rebates they negotiated and retained, as well as what they pay for drugs and how much they reimburse pharmacies. This would have removed the link between drug price and reimbursement received by PBMs in Medicare Part D drug plans and shifted the payment model to flat fee.

The agreement would also have required the industry to pass on any discounts to health insurance sponsors, which include insurers and employers in the commercial insurance market. This would have effectively eliminated so-called spread pricing – in which PBMs withhold a portion of the payments they receive for medications from pharmacies – from Medicaid.

The effort was aimed at increasing transparency and changing the industry’s compensation structure, said Ross Margulies, a partner at Manatt, Phelps & Phillips, a law firm specializing in health care. There is concern that PBMs may have an incentive to favor more expensive drugs because they can negotiate larger discounts for them.

The PBM trade group argued that the legislation would have weakened its ability to reduce drug costs and could have led to higher premiums for seniors.

“This bill does nothing to reduce costs, nothing to improve access to pharmacies, and nothing to benefit patients,” the Pharmaceutical Care Management Association said in a statement earlier this week.

But industry opponents said they were disappointed by the repeal of the regulations.

“PBM reform would rein in the big health insurance lobby, save taxpayers $5 billion and provide a lifeline for the thousands of small family pharmacies on the brink of closure,” said B. Douglas Hoey, CEO of National Community Pharmacists’ Association said in a statement on Friday.

Congress isn’t alone in trying to curb PBMs’ practices.

The Federal Trade Commission sued the largest PBMs — CVS Health’s Caremark Rx, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx — in September over alleged inflated insulin prices. According to the FTC, these three companies manage approximately 80% of all prescriptions in the United States.

“Millions of Americans with diabetes need insulin to survive, but for many of these vulnerable patients, the cost of insulin medications has skyrocketed over the past decade, thanks in part to powerful PBMs and their greed,” said Rahul Rao, deputy director of the FTC’s Office of Competition , it said in a statement at the time, adding to the agency’s actions “This represents an important step toward fixing a broken system – a solution that could spread beyond the insulin market and restore healthy competition to lower drug prices for consumers.”

The industry trade group argued that PBMs reduce insulin costs by increasing competition.

“The FTC’s action ignores the significant progress PBMs have made in reducing costs in the insulin market and is another example of the agency conducting a biased investigation with predetermined, anti-industry findings,” the association said in a statement.