CVS Caremark recently charged Wapello County, Iowa, $198.22 for a bottle of generic antipsychotic pills dispensed by a local pharmacy. CVS reimbursed the pharmacy just $5.73 for the pills.

We know about this enormous markup because one of the owners of the pharmacy, Mark Frahm, read a public notice in the local Ottumwa Courier and did some sleuthing. Frahm’s investigation ultimately had a significant  impact that continues to reverberate. Locally, it led the county jail to drop CVS as its pharmacy benefit manager (PBM) and purchase meds directly from Frahm’s South Side Drug. The move is “expected to save the county tens of thousands of dollars,” according to the Courier.