Pharmacy benefit managers (P.B.M.s) are key players in the US healthcare system, influencing which prescription drugs patients can access and how much they will cost. Acting as intermediaries for employers and government insurance programs like Medicare, P.B.M.s aim to save money on medications. However, a recent investigation by The New York Times revealed that the top three P.B.M.s are actually making patients pay more than necessary. This hidden but crucial role of P.B.M.s sheds light on the complexities and challenges faced by consumers when trying to obtain prescription drugs. With their control over drug access and pricing, P.B.M.s have a significant impact on patients' healthcare experiences and expenses. The investigation highlights the need for greater transparency and regulation in the pharmaceutical industry to ensure fair pricing and access to essential medications.