Academic Literature

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

Pharmacy benefit managers (PBMs), such as Express Scripts, CVS Caremark, and Optum Rx, are some of the larger companies that administer the Medicare Part D prescription drug benefit.

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Originally published on 03/06/2019 in JAMA Viewpoint

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.

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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