The Federal Trade Commission has released a scathing interim report highlighting the enormous power held by pharmacy benefit managers (PBMs) in the US healthcare system. These firms, which negotiate and control prescription drug access, operate with extraordinarily opaque practices that may be inflating drug costs and squeezing Main Street pharmacies for profit. The report showcases how PBMs, such as CVS Caremark, Express Scripts, and Optum Rx, have a significant impact on drug pricing, reimbursement for pharmacies, and even influence drug formularies. The top three PBMs processed nearly 80 percent of the 6.6 billion prescriptions dispensed in 2023, consolidating their power within the healthcare landscape. The FTC's investigation indicates that PBMs steer patients towards their affiliated pharmacies, resulting in excess revenue and harming independent pharmacies. The report calls for increased scrutiny of these dominant players to ensure affordable healthcare for Americans.