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Pharmacy Benefit Managers (PBMs) negotiate drug prices on behalf of insurance companies. Step edits are the practice of requiring that drugs in a certain disease area be taken in an order set by PBMs. For example, a patient may be prescribed Brand B by their physician. However, a patient may be required to take a low-cost generic and show proof it does not work, then take Brand A and show proof that does not work before being allowed to take Brand B. Net cost to the insurance company is one of several factors used to determine the order in which drugs must be taken. Manufacturers often negotiate with PBMs for a more favorable status through rebates. For example, if Brand A and Brand B both normally cost $1000, but Brand A offers the PBM a $200 rebate and Brand B only offers the PBM $100, the Brand A will have a net lower cost to insurance companies despite the same sticker price.