Illustration: Sarah Grillo/Axios

We keep mentioning “middlemen” as part of the complex, expensive drug supply chain. They’re actually called pharmacy benefit managers, or PBMs, and their role in the system is both incredibly important and incredibly opaque.

How it works: PBMs are hired by an insurance company or a self-insured employer.

  • Their job is to take care of the prescription-drug coverage for that insurance plan, which includes negotiating with drug companies for discounted prices.
  • PBMs are a big part of the reason overall drug spending has held pretty steady lately, even as sticker prices rise.

The intrigue: PBMs do this through a complex system of rebates, in which they hang onto a percentage of the discounts they negotiate.

  • PBMs' primary business model is drawing increasing scrutiny, as critics suggest it gives them a perverse incentive to play along with higher drug prices. Ohio's Medicaid program, for example, recently forced its PBMs to move to a new system of fixed fees.

Axios was able to bring some light into the darkness of the PBM world earlier this year, after we obtained a copy of a contract template used by Express Scripts, the country’s biggest PBM.

  • That document helped illuminate the many subtle ways these companies are able to tilt the playing field in their favor as they work with employers and insurance plans.

Read the full investigation here to go deeper on a critical part of the health care industry.

Go deeper: Read the rest of Axios' Deep Dive on prescription drug prices

Go deeper

Updated 26 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 3 p.m. ET: 12,794,395 — Total deaths: 566,210 — Total recoveries — 7,033,187Map.
  2. U.S.: Total confirmed cases as of 2 p.m. ET: 3,278,946 — Total deaths: 135,066 — Total recoveries: 995,576 — Total tested: 39,553,395Map.
  3. States: Florida smashes single-day record for new coronavirus cases with over 15,000 — Miami-Dade mayor says "it won't be long" until county's hospitals reach capacity.
  4. Public health: Ex-FDA chief projects "apex" of South's coronavirus curve in 2-3 weeks — Coronavirus testing czar: Lockdowns in hotspots "should be on the table"
  5. Education: Betsy DeVos says schools that don't reopen shouldn't get federal funds — Pelosi accuses Trump of "messing with the health of our children."

Lindsey Graham says he will ask Mueller to testify before Senate

Photo: Tasos Katopodis/Getty Images

Senate Judiciary Chairman Lindsey Graham (R-S.C.) tweeted Sunday that he will grant Democrats' request to call former special counsel Robert Mueller to testify before his committee.

The big picture: The announcement comes on the heels of Mueller publishing an op-ed in the Washington Post that defended the Russia investigation and conviction of Roger Stone, whose sentence was commuted by President Trump on Friday.

4 hours ago - Health

Florida smashes single-day record for new coronavirus cases

Data: Covid Tracking Project; Chart: Axios Visuals

Florida reported 15,299 confirmed coronavirus cases on Sunday — a new single-day record for any state, according to its health department.

The big picture: The figure shatters both Florida's previous record of 11,458 new cases and the single-state record of 11,694 set by California last week, according to AP. It also surpasses New York's daily peak of 11,571 new cases in April, and comes just a day after Disney World reopened in Orlando.