The PBMs are the devil. There should be some restrictions on certain unproven drugs but a lot of their decisions are profit driven. They change their formulary constantly, depending on the rebates they get from the drug manufacturers. They make physicians fill prior authorization and they expect pharmacists to be the bad guy and enforce their policies, while sometimes not paying pharmacists above the cost of the drug. They don't pay for preventive therapy. They do all of these for one reason: maximize the bottom line. They only provide a service, not a product like pfizer, but yet, they make billions in profit a year.