Over the past several months, drug makers have been particularly vocal in blaming pharmacy benefit managers — the middlemen who negotiate favorable insurance coverage for medicines — for rising prices. PBMs and insurers, in turn, blame drug makers. The truth lies somewhere in between, according to Linda Cahn, a consultant who advises health plans and employers on PBM contract negotiations. However, she does fault PBMs for a lack of transparency and certain contracting practices. So we asked her to briefly explain some of these issues. This is an edited version.

Pharmalot: Last fall, Mylan CEO Heather Bresch argued before Congress that prices ratchet up so drug companies can recover rebates paid to pharmacy benefits managers. Was she correct?

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