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Adapted from a Pew report; Chart: Axios Visuals

As part of its plan to lower prescription drug prices, the Trump administration wants to restructure pharmacy benefit managers' business models. It wants them to profit from flat fees, rather than the complex rebates they rely on now.

Context: The administration and the pharmaceutical industry argue that because rebates are tied to drugs' list prices, making those rebates less lucrative for PBMs will help bring down prices overall.

Yes, but: This transition to a new business model is already happening on its own, my colleagues Caitlin Owens and Bob Herman note. And drugs' list prices are not coming down.

  • PBMs are keeping a smaller share of rebates and passing more along to their clients.
  • Instead, PBMs are collecting more revenue through various fees — the same shift the Trump administration envisions — and through a practice called "spread pricing," according to a Pew analysis.
  • Express Scripts, one of the largest PBMs, explicitly told investors last year it would find "an alternate funding / pricing structure" to offset lost rebate dollars.

The bottom line: "One can call something a rebate, a flat fee or an elephant. It still represents a lucrative flow of money, and the influence that goes along with it,” said Robin Feldman, a UC Hastings law school professor who recently wrote a book exploring these deals.

Go deeper: PBMs are feeling the financial squeeze of back-end drug rebates

Go deeper

Justice Department sues Google over alleged search monopoly

Illustration: Lazaro Gamio/Axios

The Justice Department and 11 states Tuesday filed an antitrust lawsuit against Google, accusing the company of using anticompetitive tactics to illegally monopolize the online search and search advertising markets.

Why it matters: The long-awaited suit is Washington's first major blow against the tech giants that many on both the right and left argue have grown too large and powerful. Still, this is just step one in what could be a lengthy and messy court battle.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Politics: Americans feel Trump's sickness makes him harder to trustFlorida breaks record for in-person early voting.
  2. Health: The next wave is gaining steam.
  3. Education: Schools haven't become hotspots.
  4. World: Ireland moving back into lockdown — Argentina becomes 5th country to report 5 million infections.

In photos: Florida breaks record for in-person early voting

Voters wait in line at John F. Kennedy Public Library in Hialeah, Florida on Oct. 19. Photo: Eva Marie Uzcategui/AFP via Getty Images

More Floridians cast early ballots for the 2020 election on Monday than in the first day of in-person early voting in 2016, shattering the previous record by over 50,000 votes, Politico reports.

The big picture: Voters have already cast over 31 million ballots in early voting states as of Tuesday, per the U.S. Elections Project database by Michael McDonald, an elections expert at the University of Florida.