Pharmacies have to have crazy high prices though because PBMs reimburse at such shit rates, based on some percentage of the price given to them. Because if they buy the bottle at $30 and list the price at $60, the PBM contract will only reimburse at the adjusted wholesale price (another made up number), eg: 17% plus a $1.99 dispensing fee. This disgusting math results in getting a loss on the drug.
Even all this leaves out some of the most absurd abuses of PBMs. They set minimum drug copays, have the pharmacy collect a $15 copay for a $5 drug, and have the pharmacy pay the PMB the $10 difference. They make it a breach of contract for the pharmacy to inform the patient this is happening or to charge the $5 and bypass the insurance. The total lack of anything even approaching ethnics is absurd...
This is an extremely politicized question in the US, where a public health insurance option (a solution that's popular in much of the rest of the OECD) is fiercely opposed by a large swath of the population.
At the very least though, in an ideal world, payers, providers, pharmacies, and PBMs should not be allowed to be part of the same company.
And yes, get rid of PBMs. They are toxic middlemen who want their 'cut' for doing nothing at all.
See Gale (2023): https://pmc.ncbi.nlm.nih.gov/articles/PMC10441264/