"Two of the biggest sources of traditional PBM profit are dispensing margin on specialty drugs and retention of manufacturer rebates. Both are calculated as a factor of list prices -- and as those list prices increase, so does your PBM's profitability.... [A] closer look at supply chain economics reveals that pharma's net profit on brand drugs may actually be shrinking, and generic drugs have been steadily deflating for 10 years or more. If prices at the counter continue to rise while manufacturers' profits fall, where are those dollars all going? They are quietly absorbed by the world's most sophisticated middleman, the traditional PBM."

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