> Setting aside what happens for the uninsured (which is important, I'm just trying to simplify for my own understanding), isn't this mostly the levying of cost

> Setting aside what happens for the uninsured (which is important, I'm just trying to simplify for my own understanding), isn't this mostly the levying of costs of very expensive drugs onto the insurance providers, rather than the patient? Meaning the "victim" of the price gouging is the insurance company? The article touches on this, but perhaps doesn't spell it out sufficiently: 1. Insurance companies have their profits legally capped 2. To get around this: somehow (merger, purchase &c.) end up with Company X that owns both an insurance company and a PBM 3. The PBM price gouges the insurance company, increasing PBM profits (which is legal, unlike increasing the insurance company profits) 4. The Insurance company passes the price-gouging on in the form of increased premiums. 5. Company X makes more money by charging higher premiums, just like it would if it had (illegally) increased the profit margins of the insurance company.