There is a major player in the U.S. health care system that flies under the radar but wields tremendous power in determining who gets access to life-saving medication. A group of businesses called Pharmacy Benefit Managers, or PBMs, set prescription drug benefits nationwide — and instead of passing savings they negotiate onto patients, these firms pocket the proceeds and reap gargantuan profits.

A tiny handful of PBMs, most of which are owned by insurers, control nearly the entire market, shape the benefits of hundreds of millions of Americans, and boast sky-high revenues — yet most people don’t know they exist, and they have long skirted federal oversight.

“Although many people have never heard of pharmacy benefit managers, these powerful middlemen have enormous influence over the U.S. prescription drug system,” said Federal Trade Commission (FTC) Chair Lina Khan in a June press release on the matter.

In today’s Cheat Sheet, exclusively for supporting subscribers, we will teach you all about PBMs, explain why they’re so dangerous, and highlight what can be done to stop them.

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