Part II of "The Great Repricing" turns to the commercial insurance channel, focusing on pharmacy benefit managers (PBMs). PBMs still hold significant control, overseeing formularies for most commercially insured Americans and facing little near-term risk of losing plan sponsor clients en masse.

But their staying power looks different through an economic lens. While the PBM system appears stable on the surface, the financial foundations propping it up are eroding — suggesting real disruption may be closer than it seems.

The core threat isn't regulatory but structural: misalignment in the pass-through rebate model, formulary design, and the incentives used to direct prescribers, patients, and pharmacies toward certain drugs.