Putting these GPOs closer to where the medication is manufactured allows them to negotiate better prices.
The very cynical part of me says that creating an organization that negotiates directly with pharmaceutical companies
and receives the post-sale discounts rebates and fees and concessions in countries that are XUS,
particularly as the conversation about them started to get more political is a little bit suspicious, shall we say.
So it's not that by adding more steps to the process, these organizations have added more competition.
Sometimes they will sell to smaller PBMs through the GPO, but those PBMs may or may not get 100% of what manufacturers are paying the GPO.
And so I don't see it reducing complexity, reducing cost, really anything because we're still paying so much more than the rest of the world.
Do you think the PBMs are because they're so big or a big part of the problem?
So I see drug costs in the United States being an issue where you have manufacturers who make a drug and ultimately can decide how to distribute it.
Again, sort of the uncapped secret of the pharmaceutical space is that PBMs are the customer of the manufacturers.
Everyone else doesn't matter.
So what matters is the relationship between the pharmaceutical manufacturer and really the big three.
You know, it's, I think, big five controls up to more than 90%.
So you have five companies who are able to extract significant value while the rest of us are sitting here with our hand and our mouth saying,
like, please, please, sir, may have some more about discount.
So I really think it's the relationship where...