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With both spread pricing and rebate retention, PBMs retain a portion of the fees paid to them and do not pass those on to clients. These practices incentivize more expensive medications, thereby generating higher revenue for PBMs and potentially inflated drug prices for patients. Additionally, as can be seen in Figure 19, there is limited competition within the PBM market, with three PBMs managing approximately 80 percent of all prescription claims in 2024

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Walton Goggins' character is a great example of that