Why prescription-drug costs have soared in recent years remains unknown for millions of Georgians, largely due to a complex web of interactions between behind-the-scenes companies.

Drugmakers are far from the only players in the complex system that has led to higher medication prices and costs in Georgia since 2010. State lawmakers have recently singled out intermediary companies called pharmacy benefit managers as a major influence in rising prescription-drug costs.

State records show several pharmacy benefit managers have reimbursed local pharmacies less on average than what they charge Georgia’s Medicaid programs for prescription drugs – a difference of roughly $89 million from July 2017 to July 2019.

Those companies have faced lawsuits in several states and new regulations in Georgia aimed at reining in what critics view as harmful practices that increase drug costs – all while arguing they’ve been wrongfully targeted by state lawmakers.

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