According to an FTC report, PBMs are central to the complex pharmaceutical distribution chain that delivers medicines from manufacturers to patients. PBMs serve as middlemen, negotiating the terms and conditions for prescription access. Those who work in the industry know this, but the critical question is, “What’s going to be done about it?”

Few entities have as significant an impact on drug costs in the intricate web of the American healthcare system as Pharmacy Benefit Managers (PBMs). Established to streamline drug benefits for insurers and employers, PBMs have evolved into powerful intermediaries with substantial influence over which drugs are covered and at what price. The job of the P.B.M.s is to reduce drug costs. Instead, they frequently do the opposite. They steer patients toward pricier drugs, charge steep markups on what would otherwise be inexpensive medicines, and extract billions of dollars in hidden fees.