The law under consideration “delinks” PBM compensation from manufacturer rebates in Medicare and requires flat administrative fees, certified at fair market value. It also mandates that rebates be passed through to health plan sponsors in the employer-sponsored market. This sounds appealing, but incentives matter. When compensation no longer depends on securing better terms, bargaining effort becomes a cost center rather than a profit center. PBMs will still compete for contracts, but competition on administrative fees isn’t the same as competition on aggressive price concessions and won’t lower drug prices.
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