You go to the pharmacy expecting your medication to cost about the same as last month, maybe a small change. But this time, it’s triple the price. You haven’t changed anything. You’re on the same dose, the same refill schedule. So why is it suddenly unaffordable? Behind that sticker shock is a system that most people never see, but that affects nearly every prescription you fill: pharmacy benefit managers, or PBMs. They’re the middlemen in the prescription drug world. And the