Comment by nradov

The PBM industry originally started with noble intentions, even if some of them have now morphed into something closer to parasites. They helped to hold down drug costs for consumers and employers by negotiating with pharmaceutical companies and retail pharmacies on behalf of multiple buyers. And they created formularies and clinical guidelines to encourage use of most cost effective drugs (generics and step therapy). A lot of doctors tend to write prescriptions for certain drugs out of habit without carefully considering what's best for and individual patient, both clinically and financially. And before federal laws were tightened up, it was common for drug companies to essentially bribe doctors to prescribe their expensive branded products through loopholes like paying them "speaking fees" to show up at company meetings held at 5-star resorts. So PBMs were a way to counteract that. But then some of the PBMs started taking kickbacks themselves and making money on pharmacy price spreads so it has all become a big mess.