This is the secret drug pricing system middlemen use to rake in millions bloom.bg/2CHtdw8
For example, lets say a drugstore buys a hypothetical bottle of pills for $6 
When someone uses employer-provided insurance to fill a prescription, their pharmacy benefit manager (PBM) pays the pharmacy to cover the cost—$8 for the pills in this example, allowing the pharmacy to pocket $2
The pharmacy benefit manager also bills the employer for the pills—$16 in this case
The difference in what the PBM paid the pharmacy and what it billed the employer is the spread—which the PBM keeps
As you can see, the prices change frequently and can vary widely
To probe what middlemen make, Bloomberg examined the prices of 90 of the best-selling generic drugs used by Medicaid managed-care plans. In 2016, the drugs made up a large portion of Medicaid’s spending on generics bloom.bg/2N2owSB
The biggest markups tended to come on newer generic drugs. In 2017, markups in some states increased the price paid by state Medicaid plans for generic versions of the Novartis AG’s leukemia pill Gleevec by as much as $3,000 per prescription
Aripiprazole, a generic antipsychotic drug that was one of the most costly drugs to Medicaid programs in 2016, was heavily marked up. The market price dropped during 2017 to about $20 a month, but many state Medicaid plans were still paying more than $140 a month for the drug
In late 2017, private Medicaid plans in Indiana spent more than $800 for a 30-day supply of entecavir, a hepatitis B pill that cost pharmacies less than $140 to buy
Indiana state plans paid more than $100 per prescription for generic versions of the heartburn drug Nexium, which cost pharmacies less than $25 at the time
