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A massive lawsuit over the nation’s opioid crisis has largely ignored an influential group of companies in the prescription drug business — the financial middlemen who brokered access to the powerful pills that got so many people hooked.

Perhaps that’s because their role is simply harder to see. Known as pharmacy benefit managers (PBMs), these companies secretly make the rules that determine the availability of drugs, and how much patients must pay out of pocket to get them.


But now a community in South Texas is calling PBMs into the fight, filing what its lawyers believe is the first case in the country to name these companies as defendants in a municipal opioid lawsuit.

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