Rep. Frank Pallone Jr. (D-N.J.), who is slated to be the next chairman of a House committee overseeing drug prices, said Wednesday that his top priorities on the issue are allowing Medicare to negotiate prices and speeding the approval of cheaper generic drugs.

Express Scripts Holding Co. and other pharmacy-benefit managers make money by negotiating drug prices on behalf of health-plan providers. The list prices that pharmaceutical companies set for their drugs diverge wildly from their real cost, and PBMs widen and feast on the gap, which helps make them some of the principal beneficiaries of America’s byzantine pricing system.

Supporters of the nation’s health law condemn them. A few states, including California and New York, have banned them. Other states limit them.

Access to high-quality healthcare was a recurring theme last week at the National Alliance of Healthcare Purchaser Coalitions’ annual conference in Washington, D.C. 

The lower premiums in urban areas were partially connected to more competition among plans and providers. Having more plans also means they can spread the financial risk rather than having one or two payers shoulder all of it, leading to lower premiums.

The scene is shadowy, and the background music foreboding. On the TV screen, a stream of beleaguered humans stand in an unending line.