After years of frustration with mega companies, a group of four Kansas pharmacists is working to change the pharmacy benefit manager trade from the inside out – by creating their own, different kind of pharmacy benefit manager called Oread Rx.Nate Rockers, owner of Rockers Pharmacy in Paola, Kansas, said the current pharmacy benefit manager situation is dire.“The industry has morphed away from what we think is the right practice, in an industry that is rife with opportunities for abuse,” Rockers said.The Kansas company formed in late 2018 is aimed at disrupting a multi-billion dollar industry where major companies decide how much people pay for drugs in their insurance plans, and critics say the pharmacy benefit managers are making big profits in the process while lacking transparency.To understand what is different about Oread, it helps to understand the complex business of pharmacy benefit managers, also known as PBMs.PBMs: the ‘middlemen’ of the pharmaceutical worldHealth policy expert Karen Van Nuys is the executive director of the University of California Shaeffer Center’s Value of Life Sciences Innovation, a research program aimed at transforming health care.Pharmacy benefit managers were created in the 1960s when insurance companies started offering prescription medication as a benefit.