WASHINGTON — The Trump administration wants to tweak Medicare rules to lower patients’ out-of-pocket costs at the pharmacy counter.

It sounds simple, but the policy proposal it outlined on Monday is anything but. The actual idea takes aim at the fees some pharmacies pay to some drug makers as part of their contracts with insurance companies or pharmacy benefit managers. It’s separate from the administration’s other hints at changing Medicare “rebates” that flow from drug makers to PBMs to negotiate favorable treatment on a drug formulary.

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