The perverse incentives of insurance companies and an equal if not greater factor than regulator burden. Insurance companies are not incentivized to lower cost

The perverse incentives of insurance companies and an equal if not greater factor than regulator burden. Insurance companies are not incentivized to lower costs, because it allows them to charge more. Pharmacy Benefit Managers eliminate the price bargaining power of even the largest pharmacy chains. Healthcare is complex, expensive, and required for life, which make it inherently susceptible to market distortions.