Pharmacist and patient discussing medication

Share the Savings: If Insurers Don’t Pay      Full Price for Medicines, Seniors          Shouldn’t Either

Many Medicare beneficiaries struggle to afford the medicines they need, even as insurers and pharmacy benefit managers (PBMs) in the Part D program receive significant rebates from drug manufacturers that lower the prices they pay for medicines.


Amount rebates lowered the average price Part D health plans paid for medicines to treat certain disease[1]

44 Billion

 Total manufacturer rebates received by Medicare Part D insurers in 2020[1]

But these savings aren’t always shared with Medicare beneficiaries at the pharmacy counter. Instead, the amount patients pay is based on the medicine’s full price, not the discounted price PBMs negotiate and their health plan pays.



$100 price for medicine

Health plan receives $40 rebate

Health plan pays $0


$100 price for medicine

Health plan receives $40 rebate

Health plan pays $60

Patient Out-of-Pocket Costs

Patient Out-of-Pocket Costs

This practice is pervasive across the Medicare Part D Program.

92% of beneficiary out-of-pocket

spending on brand medicine is based

on the undiscounted list price.[2]

9 in 10 beneficiaries taking brand

medicine are exposed to the full price

through deductibles and coinsurance.[2]

Experts have warned this broken system leaves patients and Medicare paying more for a medicine than Part D health plans ultimately pay.

“Beneficiaries and Medicare may pay more than drugs’ costs to the plans.”

-MedPAC, September 2022

Share the savings with seniors at the pharmacy would deliver immediate relief to millions of Medicare beneficiaries.


Congress can help lower costs for seniors who need medicines.

  • Require Part D insurers to share the same price they pay for medicines with seniors
  • Base seniors’ cost-sharing requirement on the net price insurers pay

Sharing the savings would help seniors and bring greater fairness to the Medicare program.

  • Helps seniors afford the lifesaving medicines they desperately need
  • Strengthens the Part D program with a modest impact on premiums


Medicare Part D beneficiaries should never have to pay more for their medicine than their insurer pays. Let’s make sure insurers and PBMs share the savings directly with Medicare beneficiaries and help all seniors receive the care they need.


  1. PhRMA. "Trends in Out-of-Pocket Spending for Brand Medicines in Medicare Part D." May 2021.

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