In December 2023, for example, CVS Health — which operates more than 9,000 pharmacy locations and the nation's largest PBM by market share, Caremark — announced that as of 2025, it would shelve longstanding pricing practices to adopt what it termed simpler and more transparent approaches "built on the cost of the drug, a set markup, and a fee that reflects the care and value of pharmacy services." c Other PBMs have announced similar approaches. These shifts would not have happened without the marketplace and political pressures reaching a boiling point such as that author Gladwell wrote about.