Several years ago, I worked as a data scientist for Express Scripts, before it was acquired by Cigna. I can't much speak to the macroeconomics of PBMs, but I can say that they were the worst technical organization I ever worked for. They were built out of mergers on top of mergers on top of acquisitions, so their IT systems were what you get when you duct tape a dozen legacy systems together.

I worked in the "Innovation Lab", which had been designed to look like an ad agency's idea of Innovation -- brushed metal, Edison lightbulbs, that kind of thing. They'd bring clients through on tours to show off how much Innovation was going on. Meanwhile, I didn't really have that much to do, and no one seemed very concerned about that. Soon I realized I was also part of the decoration - a genuine Data Scientist, hard at work Innovating.

Our group produced approximately nothing. Our boss's boss was evaluated mostly based on how much he was able to sell people's medical data for.