Investing.com — Shares of American health-care companies owning pharmacy benefit management units saw a decrease in value again on Tuesday, extending Monday’s fall. This followed a statement by Pfizer (NYSE:PFE) CEO Albert Bourla that President-elect Donald Trump is firmly dedicated to reforming the pharmacy benefit management (PBM) system.

UnitedHealth saw a decrease of up to 2.9%, while Cigna (NYSE:CI)’s shares fell up to 4.1%. CVS Health (NYSE:CVS) also experienced a dip, with its shares slipping by as much as 2.5%. Bourla’s comments came after a recent dinner he had with Trump.

Pharmacy benefit managers negotiate drug prices with pharmacies and drug manufacturers. They also help to create drug coverage lists for health plans, primarily for employers and the government. They also reimburse pharmacies directly for prescription drugs included under their agreed terms.

Trump has previously referred to these entities as the “horrible middleman” that earns more than drug companies without providing significant value. He has expressed his intention to eliminate their role to reduce drug costs.

Major players in the U.S. pharmacy benefit market include CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth Group (NYSE:UNH)’s Optum. Their parent companies also operate health insurance and pharmacy businesses.

In response to Trump’s comments, a spokesperson for CVS told Reuters that the company uses free-market competition to counteract pharma price gouging. The spokesperson also expressed the company’s pride in their ongoing work to make prescription drugs more affordable in the United States and welcomed discussion with federal and state officials about its value.

ExpressScripts and Optum were not immediately available to comment on the issue.

The influence of pharmacy benefit managers over prescription drug prices has recently been under investigation by the House Oversight Committee.

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