They only hit the 80/20 because of the account-keeping shenanigans allowed by the PBM/manufacturer/plan negotiations. It would not surprise me if the rebate system were completely done away with and health plans had to spend the real amount compared to what they "spend" now, that premiums would go down and/or coverage would go up. I don't believe for a second that there are any such backroom negotiations involving a mostly-invisible 3rd party (the PBMs) that benefit patients in any way.