As someone with experience I. The PBM world, they are the only actors in a position to do the "responsible" thing. The problem though, is spread. Which is the f

As someone with experience I. The PBM world, they are the only actors in a position to do the "responsible" thing. The problem though, is spread. Which is the foundational profit taking mechanism of most PBM's. Their profit is the difference between the amount of money they estimate they'll need to cover the group, and what they actually pay out based on the gray area between their benefit schedule. That money is investable as float. This means that the higher drug prices are, the more money they have to manage. This, combined with things like pharmaceutical manufacturer rebates, disincents actual downward pressure on drug prices. If you want to get to the bottom of problem of the medical supply chain in the U.S., crack open, investigate with a fine toothed comb, and regulate PBM's. Preferably sacking everyone working there who utters the phrase "we want to be responsible financial stewards by making sure it's harder for people to get the care they need".