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Amazon’s purchase of the online pharmacy PillPack answered long-lingering questions about whether and how it would enter the prescription drug business. But it also raised another big issue: What will it do about the PBMs?

Pharmacy benefit managers are the companies that stand in the middle of the nation’s supply chain for prescription drugs. They administer drug benefits on behalf of employers and labor unions, and negotiate prices and reimbursements with drug makers and pharmacies that stand on either end of those transactions. In other words, they control access to the medicines and hundreds of millions of U.S. customers who take them.

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It was a PBM that largely blocked Amazon’s initial effort to disrupt the prescription drug business through its investment in drugstore.com in the late 1990s. And the PBMs are still standing in the company’s way now.

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