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They started as simple claims processors. Then, over three decades of mergers and shifts in business strategy, pharmacy benefit managers emerged as powerful conglomerates with the ability to extract billions of dollars in payments from the largest players in the nation’s drug supply chain.

And now, as their role in prescription drug pricing comes under increasing scrutiny, the nation’s biggest PBMs are changing shape again — this time by aligning themselves with the nation’s largest insurers.

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