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For all the flak they get, the country’s four biggest pharmacy benefit managers reported a surprisingly tame average profit margin in the first three quarters of 2023: 4.5%, less than a third of their drugmaker peers.

But don’t take their numbers as gospel, experts warned.

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“It’s really easy to move money around inside the books of a vertically integrated organization,” said Karen Van Nuys, a senior fellow at the USC Schaeffer Center for Health Policy and Economics. “If one segment of your vertically integrated organization is not publishing any financial data, it’s a good place to hide stuff.”

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