[Scoundreller]

The pharmacy will buy the drug from a distributor, not the PBM. The PBM manages the insurance.

These may all be standalone operations, or one corp with its hands in each pocket: PBM, pharmacy, insurer and distributor.

[s1artibartfast]

That is correct. My point was to highlight that there is a lot more to the supply chain than manufacturer to pharmacy, with intense negotiations and fake pricing at each step