The Medicare Prescription Drug Rebate Rule

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The Medicare Part D prescription drug benefit provides our nation’s seniors with affordable drug coverage, which is more important now than ever.

The rebate rule clumsily attempts to eliminate the primary tool used by pharmacy benefit managers, or PBMs, to negotiate increased access to affordable prescription drugs with drug manufacturers. The rule would not reduce drug costs: Centers for Medicare and Medicaid Services actuaries and the Congressional Budget Office have said it would significantly increase Medicare Part D premiums and add $170 billion in Part D program costs for taxpayers.

Medicare beneficiaries appreciate the Biden Administration’s decision to delay the prescription drug rebate rule. Congress and the Administration should now permanently repeal the rebate rule and advance real solutions that protect seniors while bringing down the costs of prescription drugs.

Rebate Rule News

Morning Consult: Congress Should Act Quickly to Permanently Repeal the Rebate Rule >

Insurers, PBMs call on Congress to get rid of delayed Part D rebate rule >

Medium: The Pharmacy Benefit Podcast: “The Rebate Rule” >

Roll Call: ‘Rebate rule’ is wrong path to reducing prescription drug costs >

Letter to Congress from organizations working to protect seniors and maintain affordable access to prescription drugs

“We believe it is imperative to block implementation of this rule to protect Medicare beneficiaries and taxpayers from unsustainable cost increases.”

read the entire letter from the organizations below

  • Academy of Managed Care Pharmacy
  • America’s Health Insurance Plans
  • Better Medicare Alliance
  • Blue Cross Blue Shield Association
  • Campaign for Sustainable Drug Pricing
  • Coalition for Affordable Prescription Drugs
  • Consumer Action Council for Citizens Against Government Waste
  • Einstein Healthcare Network
  • National Adult Day Services Association
  • National Coalition on Health Care
  • Ohio School Employees Retirement System
  • Pharmaceutical Care Management Association
  • Public Sector HealthCare Roundtable
  • Teachers’ Retirement System of the State of Kentucky
  • Tufts Health Plan

Medicare Premiums Will Increase an Additional $56 Billion Over 10 Years With Adoption of the HHS “Rebate Rule”

WHEN MEDICARE PREMIUMS RISE, BENEFICIARIES IN ALL STATES PAY MORE

Methodology: The Health and Human Services (HHS) Office of the Actuary (OACT) estimated that adoption of the HHS “Rebate Rule” would cause Medicare premiums to rise $56 billion over the 10-year period 2020-2029. That 10-year premium impact was apportioned across the 50 states and the District of Columbia using 2018 Part D enrollment.

Sources:
HHS OACT “Proposed Safe Harbor Regulation.”
Kaiser Family Foundation “Medicare Beneficiaries Enrolled in Part D Coverage (2018).”

In The Media

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Research

State Health Plans Use Drug Rebates to Lower Premiums and Enhance Benefits

December, 2020

Read the results from the new Public Sector Healthcare Roundtable Survey…

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National Online Survey of Seniors Regarding the Medicare Part D Prescription Drug Benefit

December 20, 2020

In collaboration with North Start Opinion Research, PCMA conducted an online on December 17-20, 2020 with 800 respondents…

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Impact of Medicare Part D Drug Manufacturer Rebates at the Point-of-Sale

November 18, 2020

A new report by Milliman shows that over the 10-year period 2022-2031, if all manufacturer rebates were reflected at the…

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OP-Eds & Press Releases

Morning Consult: Congress Should Act Quickly to Permanently Repeal the Rebate Rule

April 12, 2021

While Congress and the Biden administration, as well as stakeholders across the prescription drug supply chain, examine policy options for addressing high drug prices, pharmacy benefit managers continue…

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PCMA Launches New Campaign Aimed At Repealing the Medicare Prescription Drug Rebate Rule

March 1, 2021

(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) unveiled a new campaign commending the Biden Administration for delaying the Medicare prescription drug rebate rule…

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Rebate Rule Effective Date Postponed to 2023

January 30, 2021

(Washington, D.C.) — In response to litigation brought by the Pharmaceutical Care Management Association (PCMA) challenging the Medicare Part D rebate…

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The Hill: The path forward for the Biden administration: Lowering drug costs without raising premiums for seniors

January 27, 2021

The new Biden administration has started off strong, taking a thoughtful approach to any number of critical health care issues…

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PCMA Files Motion to Vacate Effective Date for Rebate Rule

January 26, 2021

(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) has filed a motion for summary judgment to vacate the effective…

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PCMA Federal Policy Priorities: 21 Policies to Reduce Prescription Drug Costs in 2021

January 14, 2021

(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) today issued 21 policy solutions supported by America’s pharmacy benefit managers (PBMs) aimed at reducing prescription…

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PCMA Files Lawsuit Challenging Rebate Rule

January 12, 2021

(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) today filed a lawsuit challenging the Trump Administration’s rebate rule. PCMA’s…

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PCMA: Pharmacy Benefit Managers Ready to Work with the New Administration to Lower Prescription Costs

November 07, 2020

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Pharmacy Benefit Managers Continue to Keep Medicare Part D Premiums Affordable

October 16, 2020

(Washington, D.C.) — Pharmaceutical Care Management Association President and CEO JC Scott issued the following statement on the open enrollment season for the…

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New Report Confirms Proposed “Rebate Rule” Would Raise Medicare Premiums and Taxpayer Costs

September 08, 2020

(Washington, D.C.) — A new report, “Negative Economic Impact of Restricting Rebates in Medicare Part D,” by Alex Brill of…

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INFOGRAPHICS:

Seniors are overwhelmingly satisfied with their Part D plan

(North Star Opinion Research)

“Simply trying to eliminate rebating without any other steps threatens to drive up drug prices overall…Rebates are a key mechanism that insurers use to try to reduce net drug prices.”

– Aaron Kesselheim, Associate Professor of Medicine, Harvard Medical School
(Read more quotes: Coalition for Affordable Prescription Drugs)