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PBS radio did a piece on PBM’s a few weeks ago. The bottom line is they skim off 20% or more and are just a middle man for the other middle man, the health insurer. According to PBS, there are three of these companies that tie up about 70% of the drug market.
On top of that, these “rebates” (other people would call them kickbacks) they get, can be changed retroactively, putting small pharmacies on the hook to make paybacks.