I have fairly in-depth knowledge of the pharmaceutical industry to know that while we pay in the US $10-$200 a pill for many drugs, the cost outside of the US is $0.10-$2 a pill.
The drug companies bribe Congress to allow this.
And PBMs are the middleman, generating huge profits for ??? - what you wrote plus what is nontransparent at the state level.
From my notes taken during the presentation of a local pharmacy owner:
Caremark is the pharmacy benefit management subsidiary of CVS.
Optum, including pharmacy benefit manager, is a subsidiary of UnitedHealthcare.
Express Scripts, another pharmacy benefit manager, is a subsidiary of Cigna.