“PBMs are big. Really big. The parent insurance companies of the biggest PBMs top nearly $1 trillion in revenue annually, roughly 4% of the GDP of America. Just the top four equal 22% of national healthcare expenditures, up from 14% in 2016. And no other country has anything like the PBM industry. The revenue of American PBMs is larger than what France spends on its entire healthcare system”
https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing