Those who defend the current drug rebate system are defending higher list prices and costs for customers, HHS Secretary Alex Azar said in a speech to independent pharmacists.

“Anyone who stands for rebates, stands for ever-higher list prices, and against transparency and lower patient out-of-pocket costs at the pharmacy,” Azar said before a packed meeting of the National Community Pharmacists Association, which hosted a Congressional fly-in for its members.

The Trump administration proposes to require pharmacy benefits managers (PBMs) to give any drug rebates directly to customers at the pharmacy counter. But the PBMs have pushed back, saying they are being unfairly scapegoated.

Azar was having none of it.

“Too many patients with the highest drug costs will not get the peace of mind and lower costs they deserve unless we replace today’s system of backdoor kickbacks with one in which discounts are delivered to the people that our regulations are intended to protect: American patients,” he said.