Pharmacy benefit managers (PBMs) have recently come under fire as Congress works to lower prescription drug costs in the United States. While prescription drugs often get blamed for high premiums and costs, one industry report found that for every dollar, 11 cents is spent on brand-name medicines – while up to 20 cents is going toward administrative costs.

Healthcare entities see significant profits from their PBM subsidiaries via their mail-order and specialty pharmacies and clinical programs. This system will keep many of these companies in the Fortune 50 while prescriptions become increasingly expensive for employers and patients. There's a reason the major insurance companies and PBMs are now combined entities: There's big money in working the system to their own benefit.

All of this leaves employers and their members at a loss. Satisfaction with PBMs is now at a 9-year low, while overall Net Promoter Scores (NPS) of PBMs have dropped 30 points in the last two years. Meanwhile, the out-of-pocket cost of drugs continues to climb for patients (even taking into account the use of drug manufacturer coupons and discount cards), due to the increasing costs of drugs and continued movement to high deductible benefit design.