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After months of deliberation, the U.S. Federal Trade Commission has voted unanimously to investigate several of the largest pharmacy benefit managers, a collection of behind-the-scenes companies that have an outsized, but little-understood role in the cost of prescription medicines.

The probe will examine several controversial practices that have placed a harsh spotlight on these pharmaceutical industry middlemen, which serve as linchpins in the complex pharmaceutical supply chain. Through their unique position, pharmacy benefit managers help determine which medicines are covered by commercial health insurers and prices paid at pharmacy counters, among other things.

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