Think back to pre-PBM, the cost of generics and meds was actually higher. Managing formulary has saved $.
I took a look at a new Medicaid covered list for Illinois and they have removed many brand names because generics are available. Great way to save cost overall. I will agree with you on exec compensation but that won't impact healthcare costs, moreover, reduce XOM, CVX, Shell, BP exec pay and the cost that you pay at the pump will not be reduced.
We in the US struggle to balance profit versus expense. We indulge! Healthcare has indulged, spending will not go down. Brand companies have patent extension strategies in the works, and they can take quarterly price increases.
You make some good points, but the whole system is .....well you know.
As far as CVS being anticompetitive, its 50/50. I can see a couple companies worried but limited impact to majority. Maintenance Choice is an option available to the employer, should the employer decide for MC, then Caremark can execute. Its not b/c Caremark mandates it. Closed market system is cost effective.