To be sure, the pharmaceutical industry is not the only party responsible for skyrocketing drug costs. The flow of goods and financial transactions in the pharmaceutical supply chain is complex and composed of several players, including pharmacies, wholesalers, distributors, health insurance plans and the pharmacy benefit managers (PBMs) embedded within them. All of these stakeholders play a role in determining the ultimate cost to the consumer. In particular, the role of PBMs in determining drug costs should be more carefully interrogated. As their name implies, PBMs are responsible for managing drug formularies and drug utilization of beneficiaries, and containing drug costs for the insurance company. They negotiate substantial drug rebates with the pharmaceutical industry based on beneficiary drug utilization. Yet these cost savings are not transferred onto the patient and are in fact used to bolster profit margins. We should thus be careful not to apportion blame squarely at the door of the pharmaceutical industry, when there are other partners with skin in the game.