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Expand chart
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

Biden's centrist words, liberal actions

Illustration: Sarah Grillo/Axios

President Biden talks like a soothing centrist. He promises to govern like a soothing centrist. But early moves show that he is keeping his promise to advance a liberal agenda.

Why it matters: Never before has a president done more by executive fiat in such a short period of time than Biden. And those specific actions, coupled with a push for a more progressive slate of regulators and advisers, look more like the Biden of the Democratic primary than the unity-and-restraint Biden of the general election.

17 mins ago - Technology

Review of Trump ban marks major turning point for Facebook

Photo Illustration: Aïda Amer/Axios. Photo: Saul Loeb/AFP via Getty Images

Facebook's decision to ask its new independent Oversight Board to review the company's indefinite suspension of former President Trump is likely to set a critical precedent for how the social media giant handles political speech from world leaders.

What they're saying: "I very much hope and can expect … that they will uphold our decision," Facebook's VP of global affairs Nick Clegg tells Axios.

Updated 26 mins ago - Politics & Policy

Biden to attempt "emergency economic relief" by executive order

President Biden. Photo: Mark Wilson/Getty Images

President Biden will continue his executive action blitz on Friday, issuing two more orders in an attempt to provide immediate relief to struggling families without waiting for Congress.

Why it matters: In his second full day in office, Biden is again resorting to executive actions as he tries to increase payments for nutritional assistance and protect workers' rights during the pandemic.