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 force a major change in the way industry middlemen make their money. But that change is already happening naturally — and drug prices aren't falling.

The big picture: Pharmaceutical companies place the blame for high drug prices on pharmacy benefit managers and their complex system of rebates. The Trump administration largely agrees with that assessment, and has proposed a major overhaul that would make rebates a lot less lucrative for PBMs.

Yes, but: Rebates are already a shrinking part of PBMs' profits, and list prices of drugs aren't 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

26 seconds ago - Technology

Misinformation thrives on social media ahead of presidential debate

Joe Biden speaking in Wilmington, Delaware, on Sept. 27. Photo: Roberto Schmidt/AFP via Getty Images

A baseless conspiracy theory that Joe Biden would wear an electronic device in his ear during the first presidential debate on Tuesday went viral on social media hours before the event.

Why it matters: The conspiracy originated on social media before appearing in a text message sent by President Trump’s re-election campaign to supporters. It was then regurgitated by media outlets like Fox News and New York Post, who cited the Trump campaign, throughout the day, according to NBC News.

Appeals court upholds six-day extension for counting Wisconsin ballots

Photo: Derek R. Henkle/AFP via Getty Images

A federal appeals court on Tuesday upheld a lower court ruling that extended the deadline for counting mail-in ballots in Wisconsin until Nov. 9 as long as they are postmarked by the Nov. 3 election, AP reports.

Why it matters: It's a big win for Democrats that also means that the winner of Wisconsin, a key presidential swing state, may not be known for six days after the election. Republicans are likely to appeal the ruling to the Supreme Court, as the Pennsylvania GOP did after a similar ruling on Monday.

Go deeper: How the Supreme Court could decide the election

Updated 35 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 7 p.m. ET: 33,489,205 — Total deaths: 1,004,278 — Total recoveries: 23,243,613Map.
  2. U.S.: Total confirmed cases as of 7 p.m ET: 7,183,367 — Total deaths: 205,883 — Total recoveries: 2,794,608 — Total tests: 102,342,416Map.
  3. Health: Americans won't take Trump's word on the vaccine, Axios-Ipsos poll finds.
  4. States: NYC's coronavirus positivity rate spikes to highest since June.
  5. Sports: Tennessee Titans close facility amid NFL's first coronavirus outbreak.
  6. World: U.K. beats previous record for new coronavirus cases.
  7. Work: United States of burnout — Asian American unemployment spikes amid pandemic