OptumRx

Health care giants are dependent on payments Trump wants to end

An older man grabs his prescription drugs at a pharmacy counter.
A senior picks up his drug prescription. Photo: Joe Raedle/Getty Images

The 3 big health insurers that control a majority of Medicare's prescription drug coverage — CVS Health, Humana and UnitedHealth Group — are arguably the most at risk from the Trump administration's plan to eliminate rebates within Medicare.

The big picture: These companies rely heavily on rebates to offset the costs of covering seniors' prescriptions. Losing those rebates would shift billions of dollars away from them, and they could lose customers if they raise premiums to make up the difference.

Why specialty pharmacies matter

Bottles of prescription pills go through an automated packaging machine.
Pharmacy benefit managers control a lot of the specialty pharmacy market. Photo: Stan Honda/AFP via Getty Images

Expensive prescription drugs that treat complex conditions often are dispensed through specialty pharmacies, and that "specialty" label is lucrative — especially when those pharmacies are owned by the same companies that manage drug benefits.

Why it matters: State Medicaid programs and private insurance plans are paying steep markups on specialty drugs, according to industry analysts. Those costs are passed on through the taxes and premiums we all pay.