The pharmacy benefit industry is filled with conflicts of interest that results in over profiting and mismanagement of therapies. Big PBMs have highjacked the market with the lure of rebate dollars that actually increase the overall cost of pharmacy benefits in quest of "fools gold" i.e. you used to pay $300 to get back $90 in rebate dollars. Now since rebates are typically the deciding factor to win and control business, you now pay $10,000 to get back $4,000, at least perceptually, but not in reality as there are many caveats and exclusions to the rebate guarantees for which you made your decision. As well, the large consulting firms receive 5 - 10 times the revenues from your PBM than what you, the employer pays them, the PBM is now their real client, and this allows the PBM to write contracts with terms and conditions that result in higher cost year over year even though the rates and rebates are better. As well, the PBMs receive significant additional "class of trade" discounts at their mail and specialty pharmacies from PhRMA to basically promote the highest cost drugs that have the highest profits for the PBM, whether they are clinically appropriate or not. I am on a quest to help educate and change this madness. I have found a fiduciary pharmacy risk management company that contractually works in the best interest of our clients and their members, provides full access to all data and financials and most importantly has "no conflicts of interest". As in the famous words of Jerry McGuire "Help me help you".