Because someone still has to pay for the drugs through tax and/or subsidized through paycheck (if you have private insurance). You might pay 6 euros per packag

Because someone still has to pay for the drugs through tax and/or subsidized through paycheck (if you have private insurance). You might pay 6 euros per package, but that could be a 50 euro drug. The 44 euro difference is being made up through your nationalized healthcare. If by and large, most of the drugs are reasonably priced, then a flat fee structure of 6 euros is possible, because it's small enough sum that it could easily be paid by other people who is paying into the pool, but not using the healthcare service. In fact, up until 15-20 years ago, it was common for American health plans to have flat fee of $5-$10 for most drugs. That went straight out the window with emergence of more expensive medications that costs tens of thousands of dollars per patient per year, which completely skewed the average price of medications, and flat fee of $5-10 became unsustainable. Nowadays, $25-30 is the norm depending on your plan, and if your plan covers it. $50-100 is common if you insist on taking medications for which there are cheaper alternatives.