All told, the Congressional Budget Office estimated that the Democrats’ (reconciliation) bill would have diverted $266 billion in Medicare spending to pay for other programs if passed into law. Taking a quarter of a trillion dollars out of an already-stressed Medicare program would be a disaster for seniors….
reforms championed by the Trump administration … would have required negotiated savings between PBMs and drugmakers to pass directly to seniors by accounting for the rebate when determining the cost-sharing amount. Currently, patients often end up paying costs based on the sticker price of medications rather than the price that has been negotiated between the manufacturers and PBMs.
The difference between list price and net (negotiated) price has been rising in health care. That is a problem because it becomes the basis for shenanigans between payer and provider. General Motors provides dealers a rebate based on end-of-year volume but it’s probably only a few percentage points, not two-thirds of list price.