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With both spread pricing and rebate retention, PBMs retain a portion of the fees paid to them and do not pass those on to clients. These practices incentivize more expensive medications, thereby generating higher revenue for PBMs and potentially inflated drug prices for patients. Additionally, as can be seen in Figure 19, there is limited competition within the PBM market, with three PBMs managing approximately 80 percent of all prescription claims in 2024

[6] Prices varied as well, with some Tribal commercial tobacco retailers selling products at higher prices than non-Tribal competitors, while others had lower prices

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Our study emphasizes that significant gender differences were evident exclusively in cigarette consumption, where males smoked significantly more than females, whereas no notable gender differences were found in the use of e-cigarettes and shisha

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