List Price, Net Price, and the Rebate Caught in the Middle

Stacie B. Dusetzina, Peter B. Bach
March 6, 2019

Dr. Stacie Dusetzina and Dr. Peter Bach present an analysis of the implications of the Trump Administration’s proposed changes to eliminate Medicare Part D rebates from drug manufacturers, published in JAMA. The elimination of rebates in Medicare Part D alone does not guarantee a decrease in patient out-of-pocket costs. Rather, a more extensive reevaluation of Medicare Part D should be considered. Potential mechanisms for restructuring include a fee-based reimbursement for PBMs, wholesalers, and pharmacies, and an out-of-pocket spending cap on Medicare Part D for patients based on coverage phase.

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