Health and Human Services Secretary Alex Azar’s announcement of a plan to end kickbacks in the pharmacy distribution chain could shake up the multibillion-dollar prescription drug market. If put into effect by 2020 as proposed, the so-called list prices of drugs will likely plummet in the Medicare Part D system.

Some Democrats and Republicans expressed hope that the plan could be expanded to the commercial sector. But with so much at stake, don’t expect the middlemen known as pharmacy benefit managers who profit from the kickbacks to go quietly. They are marshaling an argument that could prove particularly scary to seniors who watch their Part D premiums closely.

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