Rebates Should Flow to Patients NOT Middlemen


The Trump Administration is moving forward with implementation of the Blueprint to Lower Drug Prices it released last spring. Perhaps the most anticipated changes are policies that aim to curb the improper flow of kickbacks (aka rebates) to Pharmacy Benefits Managers (PBMs). These “rebates” not only drive up prices but are used to steer patients to drugs with the largest kickback. 

“In total, each year, more than $150 billion in rebates are passed around this system—and patients are left totally in the dark,” Health and Human Services Secretary Alex Azar explained following the release of a proposed rule in February. The proposal would require that rebates on prescriptions in Medicare Part D and Medicaid be passed through to lower the price paid by the patient, instead of going into the pockets of middlemen in the supply chain.

The special interests who keep the kickbacks are working hard to kill the proposal, so it is important that physicians and patients speak out in support of it before the official comment period ends at 5pm Eastern Time on April 8.

Here’s how you can help!

Step 1: Copy these template comments:

Dear Secretary Azar,

I am writing in support of the HHS proposal that rebates on prescription drugs covered by Medicare Part D and Medicaid be passed through to patients at the point of sale.

Currently rebates are too often pocketed by middlemen in exchange for covering a certain drug while excluding others. Drug choices should be based on which drug is the best fit for an individual patient, not on which manufacturer pays the biggest bribe to the Pharmacy Benefits Manager (PBM).

However, while the proposed change will lower costs for some patients, it is not a panacea for drugs that are too expensive.

Until the root problem of widespread third-party payment for non-catastrophic needs is addressed, prices will remain bloated. To see prices drop, it is imperative to put patients in charge of their own spending and care decisions, especially for everyday medical care and medications.

HHS need look no further than the success of Direct Primary Care practices in dramatically lowering drug costs for their patients by offering them medications at near wholesale prices:

In Pennsylvania, a DPC physician saved a Medicare patient nearly $300 per month for the 4 to 5 months per year she was in the Part D coverage gap. A physician caring for underserved patients in Detroit was able to offer a patient $1012 per month savings on the patient’s eight medications. A Wichita cancer patient was quoted $2200 per month for a needed medication, but his DPC physician was able to purchase it for $6.70 and pass that price along to the patient.

To put it simply, the more entities in between patients and the care they need, and the more third-party dollars are used to pay for the care, the more expensive it will be. Congress, in tandem with HHS and other federal agencies, too often enact policies that increase third party interference and payment. It’s time to move in another direction toward excising the middlemen and encouraging competition by empowering patients to obtain high-quality, low-cost care, directly from the medical professionals of their choice.

Step 2: Visit the comment submission form, paste in the comments, modify them to your satisfaction, and submit.

The comment submission form is located at:

Thank you for speaking out! Your voice makes a difference.