The controversial role that pharmacy benefit managers play in prescription drug pricing is under fresh attack in a pair of new reports issued by two of the largest states by population in the U.S. — New York and Massachusetts — both of which are exploring ways to curtail various business practices used by these little-understood middlemen.

The efforts come as a growing number of states are grappling with the rising cost of medicines, a pocketbook issue that is vexing Americans and straining government budgets. In response, state lawmakers are pursuing legislation and regulations targeting not only drug makers, but also PBMs, which occupy an important but perplexing part of the opaque pharmaceutical supply chain.

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