I hope that state Rep. Natalie Mihalek is correct that pharmacy benefit managers (PBMs) improve the flow and efficiency for the sale of prescriptions (“Anticipated drug shortages highlight need for health care industry collaboration,” Aug. 11, TribLIVE). We could have more confidence in that if we knew where the money goes, especially the “discounts” or rebates the PBMs say that they achieve.

The claims seem to be that they cannot be disclosed for some reason or other — a necessary trade secret. The patients, insurance companies or government agencies that pay for these prescriptions need to know.

Richard E. Ralston

Newport Beach, Calif.

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