Good morning ... Hope you had a good weekend and didn’t lose your mind too much when everyone just agreed that 6:00 is going to be 7:00 now, as if that’s not a potent reminder that time is a construct and we’re all simply floating in space.
Illustration: Caresse Haaser, Rebecca Zisser/Axios
The debate over high drug prices has been a maze of deflection and circular finger-pointing. But now, a lot of those fingers are starting to point in the same direction — at pharmacy benefit managers. They’re the middlemen between drug companies and insurance coverage.
Between the lines: PBMs have helped bring down net spending on some drugs, according to data from industry reports. But as my colleague Bob Herman notes, they also have profited from secretive rebates and raised concerns about whether they have exploited their market power.
Yes, but: Squeezing the middleman can only take you so far.
Go deeper: Bob has more details about how PBMs ended up in the hot seat and what it means for the larger health care debate.
Here’s one bright spot for the 10 Senate Democrats up for re-election this year in states that President Trump won: Their constituents aren’t too fired up against the Affordable Care Act.
Why it matters: Repeal is still a strong motivator for the GOP base, but that’s about the extent of its political potency. And most of these 10 Democrats have already tried to stake out a middle ground on health care, opposing the ACA repeal while also not joining their party’s shift toward embracing a single-payer system.
Sure, the ACA and Medicaid are being pulled to the right in states like Kentucky, Indiana, Arkansas, Idaho and Iowa. But as the Kaiser Family Foundation’s Drew Altman argues in today’s column, the waivers and other changes could actually put both programs on more solid political ground.
What to watch: Republican governors and lawmakers will own the changes they’ve made, Altman writes — so they’re more likely to defend not just the changes, but the programs in their rewritten form. That means the state leaders might be less supportive of ACA repeal and Medicaid cuts, and they might be able to convince donors and other powerful Republicans to back off, too.
Go deeper: Read the column on Axios.com.
Insurance companies game the Medicare Advantage ratings system by merging low-quality plans into high-quality plans, according to the Wall Street Journal.
How it works:
Yes, but: A provision of the new tax law is expected to cut down on this practice.
Senate HELP Committee hearing Thursday on the 340B drug discount program.
What's on your radar? I always welcome your tips: email@example.com.