PBMs do indeed pile-on and profiteer, however manufacturers are fleecing U.S. consumers specifically and exclusively.

Profits in the U.S. for drug manufacturers on a per-drug level are significantly higher than in other countries.

By saying the admin should leave the innocent manufacturers alone, you're papering over this fact. Numerous experts on this issue have suggested the government needs to negotiate with pharma companies directly. Now the admin is doing just that you're saying those companies should not be negotiated with and they're innocent of all profiteering, a suggestion not sustained by the facts.

I believe you are correct that the list pricing from manufacturers is higher in the US.

But my understanding is that this is due to the PBMs punishing manufacturers for lowering the list price. Lower list price means less profit for the PBMs for the discount they negotiate