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A pill that costs $47 to make can sell for almost $10,000 at the pharmacy counter. Legally. Every day.It's a generic cancer drug called imatinib. Cost Plus sells the exact same pills for $59. Same molecule, same factory, same FDA approval.So where does the other $9,900 go?Three companies decide what your prescription costs: CVS Caremark, Express Scripts, and OptumRx. Together they run roughly 80% of US prescription claims. They're pharmacy benefit managers, and their core move is spread pricing: