If you are a CEO of a self insured companies and you want to know what the problem with pricing on medications do this: Call your PBM and ask for 1. A list of all your pharmacy claims the last month and the net price for each 2. A price list of all net prices 3. Why a drug that is just a pill, is considered a specialty drug 4. Who pays for the rebates you get (hint, it's your sickest employees) 5. Why they reimburse your local pharmacy less than their cost and charge them crazy fees 6. If you can discuss your PBM contract with anyone 7. Why you can't add @costplusdrugs to your network, for when our prices are cheaper than theirs 8. Why you can't call a manufacturer to discuss adherence or wellness programs with the company who created the drug 9. Why they don't provide claims data to the manufacturer to help them improve the safety profile 10. Why they sell positioning on their formulary rather than using it exclusively for clinical value 11. Whether they calls doctors to get them to change scripts to the PBMs white label biosimilar 12. Why your consultant didn't tell you any of this The level of opacity that the big PBMs create is why the price of brand drugs are outrageous