> Over the past decade these firms have quietly increased their presence in America’s vast health-care industry (see chart ). They do not make drugs and have not, until recently, treated patients. They are the intermediaries—insurers, chemists, drug distributors and pharmacy-benefit managers (PBMs)—sitting between patients and their treatments. In 2022 the combined revenue of the nine biggest middlemen—call them big health—equated to nearly 45% of America’s health-care bill, up from 25% in 2013.

Their answer to the question "who profits most?" is this category of company. That's still compatible with the fact that the manufacturers of the pharmaceuticals have extremely high profit margins.

The article says Big Health, which is defines as the middle-men between providers and consumers (such as perscription benefit management system), takes the biggest slice of the cake.