The Federal Trade Commission (FTC) has just spotlighted some of healthcare’s most shadowy players. In a 71-page report, the agency blasted pharmacy benefit managers (PBMs) as “powerful middlemen” responsible for inflated drug costs. This newfound scrutiny marks a regulatory U-turn towards an industry where ~80% of US prescriptions are priced by three companies.

• PBMs negotiate drug prices, pay pharmacies, and decide drug availability for healthcare plans — initially meant to lower costs, their opaque business practices create murky power dynamics.
• PBMs allegedly steer patients to affiliated pharmacies selling drugs up to 200x higher while limiting access to cheaper alternatives through exclusive distribution arrangements.

Cat and mouse, but make it drugs: Antitrust lawyers argue PBMs have “done a very skillful job in avoiding regulation” by frequently shifting business models to stay ahead. However, with pressure mounting, bipartisan support is against the complex PBM web — and oversight is heating up. The FTC is now preparing to sue the three largest PBM owners, launching an assault on UnitedHealthUNH

, CignaCI

, and CVS HealthCVS

. One question looms: will these middlemen continue outsmarting the system, or will this push finally bring transparency to drug pricing?