Employers worried about lawsuits from workers charging they're not spending their health care dollars wisely are increasingly casting a more critical eye on the middlemen that help manage their drug costs.

Nikki Bryant is striving for profitability at her town square business while battling the influential pharmacy benefit managers that threaten independent pharmacists across the U.S.

The biggest pharmacy benefit managers are profiting by systematically underpaying independent drug stores, creating "pharmacy deserts" across the country.

This brief provides an overview of the Medicare Part D program, plan availability, enrollment, and spending and financing, based on KFF analysis of data from the Centers for Medicare & Medicaid Services, the Congressional Budget Office, and other sources.

Local PBM markets are on average highly concentrated—as defined by the U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC)—which suggests low competition among these pharmaceutical supply-chain middlemen.

Research finds that most people take at least one prescription drug and most see their benefits to society, yet majorities see these drugs as too expensive and three in ten struggle to afford their medicines.