Axios

A contract template used by Express Scripts, the largest pharmacy benefit manager in the U.S., provides a window into how pharmacy benefit managers — middlemen that manage drug coverage for businesses throughout the country — steer negotiations with drug companies to benefit their own financial interests.

Why it matters: These benefit managers have a lot of power over the prescription drug coverage people get through their employers, and they're supposed to negotiate discounts so coverage is cheaper for insurers and employers. If they're not making it cheaper, there's less chance people will get relief from high drug prices.

Sens. Lamar Alexander and Susan Collins have proposed a market stabilization package that would include funding for the Affordable Care Act's cost-sharing reduction subsidies for three years, three years of federal reinsurance at $10 billion a year, additional ACA waiver flexibility for states, and expanded eligibility for "copper" plans.

• Alexander presented the plan yesterday to America's Health Insurance Plan's board of directors, adding that if Democratic leadership supports the bill, “it’ll be law by the end of next week." Alexander has long said the package should be included on the omnibus spending bill.

Between the lines: This doesn't solve the partisan dispute over abortion language, as it'd bar plans that offer abortion coverage from receiving federal subsidies. But it hints that there's Republican support behind a set of policy changes that could substantially lower premiums ahead of the 2018 elections.

Marilyn Tavenner is stepping down as CEO of America's Health Insurance Plans, the health insurance industry's leading lobbying organization. She will be replaced by Matt Eyles effective June 1.

Between the lines: Tavenner, who was the top Medicare and Medicaid official under the Obama administration and also helped oversee the rollout of the Affordable Care Act, had a rocky tenure in her three years at AHIP. Several of the largest insurance companies left the organization, and Republicans were not responsive to some of the industry's biggest concerns during the repeal-and-replace debate.

A new study published in the Journal of the American Medical Association reiterates 3 important things that health care wonks already know, but which our political system can't seem to internalize: (1) The U.S. spends wildly more than other countries, including other rich countries, on health care. (2) The U.S. does not have better health outcomes — all that money isn't buying us better health. (3) The U.S. doesn't use that much more health care than other countries. We just pay much higher prices for what we do use.

Why it matters: As we've said before, if you want to spend less money on health care, somebody in the health care system has to get less money, which is what makes it so difficult. And there's certainly an argument for spending a lot on health care — but you'd hope to be healthier as a result.