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As a result, manufacturers are plotting multiple simultaneous countermoves, from the conventional approach of getting onto formularies (particularly formularies for government-sponsored insurance as Medicare starts to flex its negotiation muscles) to arranging for direct-to-consumer care and delivery that bypasses PBMs for eligible patients to outright eschewing insurance contracts altogether so they can avoid rebates, the Medicaid drug rebate program, and 340B Drug Pricing Program requirements

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