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WASHINGTON — As lawmakers are puzzling over the question of why so many patients are paying so much money for prescription drugs — and what to do about it — Republicans are focusing increasing scrutiny on the middlemen: pharmacy benefit managers.

“What I’m seeing, and what the public sees, is that we’ve got this big black box called PBMs,” said Rep. Morgan Griffith, a Virginia Republican, at a Wednesday House subcommittee hearing.


On Tuesday, Sen. Lamar Alexander wondered why we need rebates — payments from drug companies to insurers, negotiated by PBMs, that reduce the price of a drug for the insurer — which is a question the Tennessee Republican has raised since October.

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