Can you explain your last thought? I dont quite follow.

I do think a lot of the rot is in the PBM layer, and the country would benefit from an attempt to eliminate it, reduce their influence, and move away from the formulary.

Insurance should dictate what is covered, NDC exclusions should be banned, and rebates should be discouraged.

Ideally manufacturers sell for a list price, and insurance decides what is an acceptable balance of cost to subscriber satisfaction.

PBMs would go back to handling the papwerwork, or better yet be replaced by an open standard protocol