In response to expensive drugs, managed care plans and pharmacy benefit managers in recent years began increasingly using rebates and concessions from pharmacies that hold down beneficiary premiums in Medicare, but CMS reports these savings are not shared with consumers, whose out-of-pocket costs are based on drug prices before rebates and concessions, and the rebates speed beneficiaries into the coverage gap, where they pay full price, and catastrophic coverage, where taxpayers pick up 80 percent of drug costs. Also, pharmacies...