How the US Government Pays Twice for the Same Prescriptions

The Fiscal Policy Podcast with Fexingo: Government Budgets, Stimulus, and Public Spending · Aug 21, 2026 · 8m · transcript

Why does the US government end up spending more on prescription drugs than it needs to? In this episode, Lucas and Luna dig into a little-known quirk of federal health programs: the government often pays twice for the same medications — once through Medicare Part D and again through Medicaid, even when the patient is the same person. They trace the mechanics of the 'dual eligible' population, the rebate rules that create the double payment, and how a simple change in rebate calculations could save billions. Along the way, they look at a real, durable example: the blockbuster…