Critics have accused the giant PBMs of using opaque pricing strategies to keep most of the drug discounts they negotiate.

In 2023, Blue Shield of California announced it was hiring Abarca and Amazon to develop a more transparent alternative to using a first-generation PBM.

Related: Blue Shield of California drops CVS, taps Amazon: What's behind the PBM shakeup

Many other payers and health policy players are also looking for ways to break up the big PBMs' cartel and make sure more of the prescription discounts go to the patients, Borschow said.

"The only issue that Democrats and Republicans are completely aligned on is that PBMs should be regulated by the government," Borschow said. "It's highly likely that we'll have disruption in how PBMs operate, and how PBMs make money. It's already happened in Medicaid. Medicare is on the way. Obviously, in a free market the commercial space is probably the last one to be regulated, but our expectation is that regulations will happen, and that PBMs' business practices are going to be regulated by the federal government in addition to state governments."

The big PBMs now have so much market power that the government may be the only entity that can change how they work, but "the government isn't always the most efficient entity when it comes to bringing solutions," Borschow said. "People believe that costs are going to go down with all these new regulations, but it's highly likely that costs are going to go up."

PBMs have decimated pharmacies' profit margins over the past five years, and some of the cost increases will be due to necessary efforts to reverse that, Borschow said.

Also at the conference:

Artificial intelligence: Eric Lefkofsky, the founder and CEO of Tempus, talked about his New York-based company's efforts to pay for the development of AI-based medical diagnostic tools by supplying the huge amounts of real-world medical data that other AI firms need to create their tools.

Generating revenue by selling the data is much easier than generating significant amounts of sales by offering AI-based health care tools today, Lefkofsky said.

Because of the regulatory requirements and the complexity of the health care system, "you almost have to sneak AI in," Lefkofsky said. "You can't come in through the front door."

Wastewater testing: The COVID-19 pandemic turned the wastewater testing programs developed by companies like Biobot into a major source of infectious disease outbreak tracking data.

A hospital, for example, can now look at Biobot reports on ups and downs in the amount of COVID-19 virus or flu virus traces in its community's water and use that to decide how many nurses it needs to have come in, according to Mariana Matus, the co-founder and CEO of the Cambridge, Massachusetts-based startup.

Matus said the testing programs have also turned out to be a great source of information about other topics, including how well efforts to fight drug overdoses are reducing the presence of drug traces in the water and what people are really eating.