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Pbms were invented to negotiate better drug rates and manage drug spend through utilization management/PA and coverage eligibility requirements
D1 said why they were created, obviously their business model has changed in the past 80 years
You can find good explainers on STAT news, KFF, Commonwealth fund, and Drug channel institute. Like any other business they deliver some value to employers/payers and extract value from the system to benefit themselves. PBMs and health insurers are running out of ways to grow the business. So business growth to create value to the shareholders is now in conflict with business growth that can create value to the market. Because the latter doesn’t exist or they can’t figure out how.
PBM is just a drug payer basically.