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In recent months ominous ads about prescription drugs have flooded the TV airwaves and Congress is paying attention: House and Senate members have launched at least nine bills, parts of which may be packaged together this fall, that take aim at pharmacy benefit managers, which channel prescription drugs to patients.

While the pharmacy benefit managers’ secrecy, ubiquity, and power make them a target of outrage, they generally operate on behalf of their customers, which are insurance plans and employers, whose goal is to hold down prices. The PBMs do that by extracting painful concessions, a double-edged sword.

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