Drug spend is predicted to experience the fastest annual growth between 2017-2026 compared to other health care goods and services.Contributing factors include increasing unit prices of branded and generic medications, growth of the specialty drug market, and greater numbers of people with access to prescription drug coverage. A recent analysis estimates total drug expenditures in 2016 to be $480 billion when accounting for gross profits of intermediaries in the distribution chain, such as wholesalers, pharmacy benefit managers (PBMs), and pharmacies. Certainly, the complexity of the drug distribution and reimbursement system and lack of pricing transparency can be viewed both as symptoms of and barriers to solving this issue.