Thankyou for your comment, Jeff. The PBM is the entity that collects rebates. PBMs have been notorious for keeping all of the rebates in the past. Anthem fired EXPress Scripts because ESI did not pass back the price concessions. As more payers are demanding rebate pass back, the PBMs (in secret contracts with the manufacturer) are reclassifying rebates as fees that do not have to be passed back. Often these admin and price protection fees dwarf the amount of the rebate. At the end of my reply is a link to an excellent piece on just how high those PBM fees are. PBMs do not want a lower list price. Their rebates and fees are based on a % of the list price, if price goes down their incomes go down. Employers need to hire “fee only, fiduciary” PBMs to save money but that may be impossible if the large 3rd party payers all merge with PBMs ala CVS- Aetna and Cigna - Express Scripts. United Health already has its own PBM, Optum RX. I hope this helps. http://nationalprescriptioncoveragecoalition.com/express-scripts-lawsui…