The hospital definitely didn't carefully consider the $40 price to cover the actual cost of delivering the medicine to you. They just multiply their cost by so

The hospital definitely didn't carefully consider the $40 price to cover the actual cost of delivering the medicine to you. They just multiply their cost by some number and call it a day. The fact is that hospitals aren't built for itemized bills because very few patients pay the posted prices out of pocket. Medical debt is extremely hard to recover in the US, so why bother expending the resources to figure out a sensible pricing structure for a small minority of your customers who mostly aren't going to pay that price anyway?