Pharmacy Benefit Managers (PBMs) in the United States are under scrutiny for practices that critics argue contribute to rising drug costs. PBMs, originally intended to save money by negotiating drug prices and rebates, have increasingly consolidated power, affecting how patients receive medications. This consolidation has led to higher out-of-pocket costs for patients, as savings negotiated by health insurance companies and PBMs are not consistently passed on to patients. Critics, including healthcare professionals and policymakers, are calling for regulatory changes, such as the removal of PBM safe harbor by the FTC, to address the issue. The problem has persisted for three decades, impacting patients and independent pharmacies.