The kickbacks are indirect of course. BigPharmaCo tells BigPharmacyChain their new wonderdrug is wonderful, expensive, and ought to be popular, and therefore w

The kickbacks are indirect of course. BigPharmaCo tells BigPharmacyChain their new wonderdrug is wonderful, expensive, and ought to be popular, and therefore well advertised in the store. Meanwhile, BigPharmaCo sends reps to hospitals and clinics to offer doctors extremely well catered business lunches and complimentary luxury vacations -- I mean "seminars" -- to encourage them to prescribe the correct medicine. It is understood but not stated that if the doctor does so, the lunches and seminars will continue, as will the flow of large quantities of drug "samples" and other medical supplies. This situation incentivizes price gouging and over prescribing. Insurance companies are thrilled with high prices because they reinforce the idea that medical insurance is critical infrastructure. Liberal politicians love taking credit for throwing money at the problem they helped codify into law, and conservative politicians love being able to decry out-of-control, cradle-to-grave socialism at every campaign stop. So yeah there are multiple layers of corruption there.