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That act of removal eliminating the PBM exposed what the industry had obscured for decades: a system of opaque markups, hidden rebates, and contractual spread pricing that extracted billions from patients, employers, and government payers while routing the money upward through three vertically integrated conglomerates that now control roughly 80% of all U.S

( com/science/article/pii/ S2773021222000621)[7] KratomPharmacology, Clinical Implications, and Outlook ( articles/PMC7203303/)[3] Narrative Review of Kratom, an Emerging Psychoactive Substance