Written by Jill Sederstrom

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One of the proposals outlined in the blueprint furthers this idea by suggesting measures to restrict the use of rebates, including making changes to the safe harbor provisions for drug rebates in the Medicare Part D program.

“The administration has the ability to modify their previous guidance that established that safe harbor, so it think it’s a very significant proposal for PBMs just given the ease with which the administration could implement it,” says Lindsay Bealor Greenleaf, director at healthcare consulting firm ADVI.

The blueprint identifies this as a “further opportunity,” though exactly how the safe harbor provisions could be altered isn’t immediately clear. Greenleaf says the most extreme—and less likely—change would be to repeal it outright, eliminating a PBM’s power to engage in rebating and discounting in Medicare Part D. A more realistic option, she said, is developing some type of policy that limits excessive rebates or discounts.

“That would have immediate impact on the PBM’s business models,” she said.

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