If you’ve been told your insurance won’t cover your meds — or that you’re gonna have to pay an arm and a leg for them — you’ve met a PBM: a pharmacy benefits manager.

And: Experts say they play a big role in jacking up drug prices overall.

But how, exactly? We took a deep dive.

This episode first went out in 2019. We’re bringing it back because PBMs are in the news these days: Congress is targeting them, in an effort to to be seen doing something about prescription drug prices. And PBMs’ sometimes-rival, the powerful pharmaceutical industry lobby, is flooding the airwaves with ads attacking them.

There’s been a little news since 2019: Although Congress is still catching up, all 50 states have passed some laws pertaining to how PBMs work. We’ve got an update on that.

Here’s a transcript of this episode.

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Correction: A previous version of this episode misidentified the parent company of Express Scripts.

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