This rebate system, as well asthe revelation that PBMs around the country are profiting hundredsof millions of dollars on Medicaid programs, has put PBMs in themiddle of a PR nightmare. (Photo: Getty)

“Eliminate the middleman.” This has become the mantra forreducing prices of prescription medication, but manyconsumers find themselves wondering just who is the middleman?

In the prescription medication universe, pharmacy benefit managers (PBMs) act asgo-betweens for insurers, drug makers and pharmacies, with thesupposed goal of controlling drug utilization and cost. These PBMsare the entities primarily responsible for producing healthformularies, the lists of prescription drugs covered in part or infull for insurance enrollees. As formulary coverage could mean thedifference between financial security or ruin, PBMs are rightfullycoming under increasing scrutiny.

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