A little-known practice in the pharma industry is under threat, and a new memo reveals how the companies that rely on it are bracing for change

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CVS Health is asking drugmakers not to increase the total cost of their drugs if rebates go away, according to a letter obtained by Business Insider.

Pharmaceutical company executives prepare to testify before the Senate Finance Committee hearing on drug prices.CVS Health is asking drugmakers not to increase the net cost of their drugs should rebates go away, according to a letter obtained by Business Insider.

A little-known practice that healthcare middlemen use to negotiate drug prices might go away, and one of the biggest company's in the space is bracing for it., which operates the pharmacy benefit manager CVS Caremark, wrote to drugmakers asking them not to increase the total cost of their drugs, should payments they typically make to PBMs as rebates go away as part of a proposed rule from the Trump administration.

But it could also benefit big drugmakers. The pharmaceutical industry, for its part, has said it supports curbing rebates. In a recent congressional hearing on drug pricing, pharmaceutical CEOs were asked about the proposed change and indicated clear support for the proposal. CVS gave an example of a $100 drug on which a drugmaker had a $20 rebate. In today's model, that would lead to an $80 net cost for the drug. CVS says that should the $20 rebate go away, the company would like to see the net cost stay at $80, instead of increasing to $100.

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