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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.

These include: 

  • PBMs do keep rebates in commercial plans. Those commercial rebates are most important and highly variable, and they're are hidden within a black box, which Bloomberg started to expose in 2016.
  • PBMs extract payments from drug companies that are not technically rebates — things like inflation payments, prompt payment discounts and many more — but they act a lot like rebates. The GAO only made a passing reference to “bona fide service fees.” 
  • The GAO acknowledges the contracts it reviewed “are not generalizable to all service agreements that are in effect,” and many agreements omitted important information because PBMs or health insurers viewed it as proprietary.

Go deeper: How Express Scripts claws back money from almost all pharmacies in Medicare

Go deeper

30 mins ago - Politics & Policy

Jen Psaki: "With that I’d love to take your questions”

In her inaugural briefing as White House press secretary, Jen Psaki said she has a “deep respect for the role of a free and independent press in our democracy,” and pledged to hold daily briefings.

Why it matters: Conferences with the press secretary in the James S. Brady Press Briefing Room became almost non-existent under the Trump administration. By sending Psaki to the podium hours after President Biden took the oath of office, the White House signaled a return to pre-Trump norms.

Avril Haines confirmed as director of national intelligence

Haines. Photo: Joe Raedle/Getty Image

Avril Haines was quickly confirmed by the Senate on Wednesday as the director of national intelligence (DNI) in a vote of 84-10.

Why it matters: Haines is the first of President Biden's nominees to receive a full Senate confirmation and she will be the first woman to serve as DNI. She's previously served as CIA deputy director from 2013 to 2015 and deputy national security adviser from 2015 to 2017.

Updated 2 hours ago - Politics & Policy

Inauguration Day dashboard

Biden delivers his inaugural address on the West Front of the Capitol. Photo by Tasos Katopodis/Getty Images

President Biden has delivered his inaugural address at the Capitol, calling for an end to the politics as total war but warning that "we have far to go" to heal the country.

What's next: The Celebrate America event, with remarks by Biden and Harris.