Four-time Academy Award nominee Annette Bening and two-time Academy Award-winner Jodie Foster give the world a joyful acting lesson in “Nyad,” and you won’t want to miss it. A feature film debut from directors Jimmy Chin and Elizabeth Chai Vasarhelyi of the terrifying, mountain-climbing documentaries “Meru” (2015) and “Free Solo” (2018), the film is based on long-distance swimmer Diana Nyad’s 2015 memoir “Find a Way” adapted by screenwriter Julia Cox (TV’s “Recovery Road”).

Slyly slipping in some archival footage, Chin and Vasarhelyi fill in the background history.

Nyad, who took her surname from the Greek word for “water nymph” at the encouragement of her father, set records swimming across Lake Ontario and around Manhattan Island and from the Bahamas to Florida (102 miles). The action begins when Nyad (Bening) tolerates a surprise 60th birthday party thrown by her best friend Bonnie Stoll (Foster).  A Boomer born in 1949, Nyad worked for 30 years for ABC News, and she hasn’t been in the water in ages. But she’s a fierce Scrabble competitor, and she doesn’t want to “succumb to mediocrity” in her old age. Like Tennyson’s Odysseus, she dreams of a crowning, final adventure, and she concocts a plan to swim from Cuba to Key West.

At the local pool, Nyad gets into the water and doesn’t get out until after dark. She’s just warming up. Speaking to a class of children, she admits that she poops in the water during marathon swims. What are the dangers? Sharks, stingrays, Portuguese man o’ wars and venomous jellyfish.

Diana and Bonnie arrange for a team of young kayakers to protect her during the swim using an electric “shield” to repel sharks. It doesn’t however work on jellyfish. After a terrible introductory meeting, Diana enlists dyspeptic charter fisherman John Bartlett (Rhys Iffans, completing an acting trifecta) as her navigator. It is inevitable that Diana, who sports a red light on her bathing cap, will vomit seawater and hallucinate during her swim. Bonnie and the team keep close to Diana in the boat, cruising at the same speed and keeping a light on the swimmer. Bonnie and John are vigilant.

During the swims, while Diana sings and counts, we see what she is thinking. We get a rather cheesy-looking version of the Taj Mahal in one of these scenes. But we also encounter her childhood, her introduction to competitive swimming, and her sexual abuse as a child by a beloved coach.

Bonnie and Diana are a gay comedy team, arguing, bantering and fighting over Diana’s willingness to risk her life. A crowd cheers Diana on her first attempt. By the fifth, Diana is older and the crowds have gone. But she and her assistants have engineered a body suit and eerie face mask that she can wear to protect her from jellyfish at night. Yes, it is exciting to see Bening, Foster, Iffans et al reenact Nyad’s relentless five attempts to make the swim. But it is the bond between Diana and Bonnie that is the film’s beating heart and its strength. In 2013, at the age of 64, Nyad sets a record for longest ocean swim without shark cage or flippers, 110 miles. She is a true legend. But the film is a celebration of two women’s friendship and of two of America’s greatest actors putting on a great show. Onward.

(“Nyad” contains scene suggesting sexual abuse, profanity and brief nudity)

“Nyad”

Rated PG-13. At the Landmark Kendall Square. Grade: A-

Congress is poised to crack down on the drug-industry middlemen responsible for inflating the price of medicines. Pending bipartisan legislation in the House and the Senate would rein in these “pharmacy benefit managers” and strengthen competition among health insurers. The big winners will be patients, who could save billions of dollars at the pharmacy.

PBMs act as brokers, negotiating with drug manufacturers on behalf of insurance companies. They decide which drugs each health plan covers, and at what price.

This decision-making power gives them considerable bargaining leverage, which they use to extract discounts from drug makers in exchange for steering patients towards one drug company’s product, rather than another’s — regardless of their therapeutic differences.

In theory, these negotiations ought to result in lower spending for patients. But it hasn’t worked out that way — because PBMs’ compensation is closely tied to the nominal “list” price of a given drug. Because PBMs take a cut of the drug’s total price, they have an incentive to steer patients towards more expensive drugs, even when cheaper ones are equally effective.

Meanwhile, the discrepancy between the list price of a drug and what insurers actually pay provides an excellent opportunity for insurance companies to bilk their customers at the pharmacy counter. They do so by basing coinsurance payments on the list price, rather than the discounted price.

For example, a PBM may negotiate the price of a drug listed at $400 down to $200. Say the insurance company the PBM is working for requires patients to pay 20% of the drug’s cost in coinsurance. The insurer then charges patients $80 out-of-pocket — 20% of the original price — instead of $40, or 20% of the discounted price. Patients don’t have a clue about the discounted price because those negotiations are conducted in secret. But insurers win by paying less and billing patients more.

Total PBM profits increased to $28 billion in 2019.

There’s little way for ordinary Americans to escape this racket. According to the American Medical Association, almost 70% of Americans with commercial health plans are insured through a company that is vertically integrated with a pharmacy benefit manager. This means both the insurer and PBM have an incentive to favor higher list prices for drugs, with no regard for the patients stuck with higher bills.

If an American wants to change providers to escape a particularly predatory pharmacy benefit manager, good luck. Just six PBM companies control 96% of the prescription medication market. Currently, it’s virtually impossible for smaller, independent PBMs to compete with the massive insurance-owned PBMs.

Congress must step in to rectify this anti-competitive situation. By ending the consolidation of the PBM market and allowing smaller PBMs to compete, Congress will be ensuring that prices come down and Americans will have more options for affordable and high-quality health care.

Shifting PBM compensation structure to remove the incentive to prefer expensive drugs will lower costs for patients, employers, and the government. Any discount secured by a PBM should be passed along to patients at the pharmacy.

Plenty is at stake if Congress fails to hold PBMs accountable. The cost of healthcare will continue to climb, and patients will get sicker. In some cases, they will forgo taking their medications as prescribed, adding billions of dollars in avoidable expenses.

Preserving the critical market features of our healthcare system and lowering costs for patients are not opposing goals. Increasing competition by breaking up and regulating PBMs will accomplish both.

Peter Pitts is a former associate commissioner of the Food and Drug Administration and President of the Center for Medicine in the Public Interest.