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Doctor and business man holding up medication concepts When a broker that is not a “fiduciary” represents a plan sponsor in a request for proposal process, the resulting contract will likely advantage the PBM, and disfavor the plan. Image: Shutterstock)

Pharmacy benefit managers (PBMs) have created opaque manufacturer rebate arrangements, either directly or through wholly owned subsidiaries. These subsidiaries, known as “rebate aggregators,” cost plan sponsors, beneficiaries and taxpayers staggering sums of money. A growing number of examples of PBMs causing economic harm to plan sponsors through rebate aggregators is publicly emerging.

Related: Vetting your contract: How to know what your PBM is really offering

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