So much of American health care can be summed up with drugs.

We often go to the doctor less to find out what is wrong than we do to get a prescription to fix the symptoms. While the long-term goal may be figuring out the underlying cause, the short-term objective is just to make the pain (or other problem) stop.

And that means a pill or liquid or some other kind of pharmaceutical. The doctor is just the first stop. The prescription sends you to a pharmacy.

Now it’s a question of whether your medicine is covered. If it’s not, you blame the insurance company. But should you? Maybe the real culprit is the pharmacy benefit manager (PBM). But do you even know what that is?

These PBMs are the new boogeyman of health care. While people have spent years grumbling about what hospitals charge for a bandage or the cost of an insurance copay, lately PBMs are getting flak for their role meddling in your treatment.

They’re nothing new. The first PBM in the U.S. came in 1965. They were created by pharmacists to help navigate the growing presence of insurance companies. Today, they are an inextricable part of the process, taking money from drug manufacturers, creating formularies for insurance and establishing reimbursement for pharmacies.

While that often leads to questions about how it impacts patient health, it’s now creating concerns about impact on independent pharmacies. (Large pharmacies can have less to worry about. CVS Health and Rite Aid each own their own PBMs.)

In Southwestern Pennsylvania alone, Health Mart and Mainline pharmacies have announced closings this year. Both have mentioned insurance reimbursements as contributing factors.

So has Mt. Lebanon native and billionaire Mark Cuban, whose businesses include Cost Plus Drugs, an online pharmacy. In an email exchange with TribLive, he spoke about partnering with independents.

“The fact that they are not getting reimbursed for even their out-of-pocket costs for a medication is horrible,” he said.

Bipartisan legislation from state Sen. Judy Ward, R-Blair, would create a process for hearing and handling complaints about PBMs. It also would ban things like steering patients to particular pharmacies or reimbursing a pharmacy for a low amount but charging the insurer more. Thirty senators of both parties have signed on.

The Pharmaceutical Care Management Association is opposed. Spokesman Greg Lopes says it will increase costs for Pennsylvanians.

But when PBMs are creating problems for patients and pharmacies alike, something has to be done. And when that’s obvious to Democrats and Republicans, that says something - even if it’s a bitter pill for the middle man to swallow.

Pittsburgh Tribune-Review