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How does a Congress that promises lower prices end up weakening the bargaining tools that restrain them? The answer lies less in ideology than in political incentives. Pharmacy benefit managers (PBMs) are opaque intermediaries—and they are unpopular with figures including Mark Cuban, who told Fortune that the way they bargain over drug prices is absurd, something that would never happen at the very same pharmacies buying a package of Pringles potato-chip products. (Cuban has been working to directly disrupt the PBM space with his business, Cost Plus Drugs.)

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