The costs are not made clear to the consumer. Usually how it works in the US is you give your insurance information to the pharmacy, then then the pharmacy tell

The costs are not made clear to the consumer. Usually how it works in the US is you give your insurance information to the pharmacy, then then the pharmacy tells you how much you have to pay. You may be told what portion the insurance paid, but that’s a portion of a cost the insurance company negotiated. You aren’t told what it would have cost if the insurance was never involved.