In 2017, the drug industry middleman Express Scripts announced that it was taking decisive steps to curb abuse of the prescription painkillers that had fueled America's overdose crisis. Why hadn't the middlemen, known as pharmacy benefit managers, acted sooner to address a crisis that had been building for decades? One reason, a New York Times investigation found: Drugmakers had been paying them not to. For years, the benefit managers, or P.B.M.s, took payments from opioid manufacturers, including Purdue Pharma, in return for not restricting the flow of pills. As tens of thousands of Americans overdosed and died from prescription painkillers, the middlemen collected billions of dollars in payments. The P.B.M.s exert extraordinary control over what drugs people can receive and at what price. The three dominant companies Express Scripts, CVS Caremark and Optum Rx " oversee prescriptions for more than 200 million. The P.B.M.s are hired by insurers and employers to control their drug costs by negotiating discounts with pharmaceutical manufacturers. They often pursue their own financial interests in ways that increase costs for patients, employers and government programs, while driving independent pharmacies out of business. Regulators have accused the largest P.B.M.s of anticompetitive practices. In addition ... P.B.M.s sometimes collaborated with opioid manufacturers to persuade insurers not to restrict access to their drugs.