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Fortune
Fortune
Erika Fry

Trump has promised to 'knock out' pharmacy benefit managers. How the drug middlemen became a $557 billion industry that its customers love to hate

(Credit: Illustration by Doug Chayka, photos from Getty Images)

In late December, President-elect Donald Trump put pharmacy benefit managers, or PBMs, on notice.

Denouncing the $557 billion industry as “horrible middlemen,” responsible for—and “rich as hell” from— America’s incomparably high prescription drug prices, Trump vowed to get rid of them. “We’re going to knock out the middlemen,” he said at a press conference at Mar-a-Lago.

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