Stories by Bob Herman

Pharmacy benefit managers pass along a lot of Medicare rebates

Prescription medicine staked on top of each other
Photo: Paul Linse/Getty Images

Pharmacy benefit managers negotiated $18 billion worth of rebates from drug manufacturers within Medicare’s prescription drug program in 2016, and they retained less than 1% of those rebates for themselves, according to a new Government Accountability Office report.

The big picture: This isn’t surprising, as Medicare is structured so that PBMs pass pretty much all rebates back to the federal government. While the GAO report offers a good base of how middlemen affect drug prices in Medicare, it does not fully address larger issues.

Health care industry kills cuts to heart pump payments

Surgeons hover over an operating table with surgical instruments.
Doctors conduct a heart procedure. Photo: Jeff Gritchen/Digital First Media/Orange County Register via Getty Images

Hospitals, doctors and medical device companies have successfully lobbied Medicare to abandon a proposed 30% cut in payments for certain surgeries involving heart pumps.

Why it matters: Regulators attempted to rein in spending on a powerful and well-financed niche, but the industry managed to preserve its payments yet again.

How the health care system fails dying patients

Illustration of a stethoscope with a knot in it.
Illustration: Sarah Grillo/Axios

Medical culture has often framed death as a binary decision: preserve a patient's life at all costs, or give up and accept what happens. That framing does a disservice to the fear, uncertainty and philosophical questions about life and death that patients and their families experience.

The big picture: American health care, from medical education all the way through to the payment system, generally does not encourage doctors to listen to dying patients' needs or priorities.