This project will examine the role of wholesalers in the pharmaceutical distribution chain and their impact on pharmaceutical drug costs. This will include an analysis of the business practices of wholesalers to help policymakers identify the most policy relevant areas to manage pharmaceutical spending and the stability the supply chain of drugs -- especially salient during the ongoing COVID-19 pandemic. The researchers will conduct a literature review of peer-reviewed literature, lay media, legal cases, and reports along with interviews of key stakeholders, which includes a representative sample of large wholesalers, small “gray” wholesalers, manufacturers, and retail pharmacies, among others. Finally, the project will tie together the findings from this and the grantee’s projects on pharmacy benefit managers and pharmacies and recommend reforms that could improve purchasing efficiency throughout the pharmaceutical distribution chain.