American voters — and their elected leaders — are fed up with the cost of prescription drugs. And they’re looking for someone to blame.

That blame ought to fall squarely on pharmacy benefit managers (PBMs) and insurers, which are siphoning off a growing share of total drug spending. Inflation-adjusted net drug prices — the average sum retained by drug companies after accounting for the rebates and discounts they offer to PBMs, insurers, hospitals, and others in the drug supply chain — fell in 2025 for the eighth year in a row.

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