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I see that Express Scripts - one of the large Pharmaceutical Benefits Manager companies - is doing online ads saying "we are not a middleman".

Well, they are a middleman, one that dictates to patients, doctors, and insurance companies what drugs, what dosages, what quantities, and what prices.

Well today I got a drug denial - as usual umpteen pages in umpteen languages, sent first class USPS. In other words it cost them several dollars to send.

And it was to tell me that my doctor prescribed an off-formulary anti-bacterial ointment that costs about $2.

Not very efficient, and very middle-man.