> It’s because Medicare gets an automatic discount (I think 20% these days but I’m no longer in the biz) from the manufacturer’s official price. So they simply

> It’s because Medicare gets an automatic discount (I think 20% these days but I’m no longer in the biz) from the manufacturer’s official price. So they simply set the official price at some huge figure and rake in huge bucks from the largest buyer, Medicare. Then they negotiate with the for profit insurance companies and subsidize the copays so that nobody complains to their congress person. This is all completely wrong, to a point where I don't even know where to begin to correct it, because there are three separate misconceptions here layered on top of each other. Not only does Medicare get most-favored-nation pricing (ensuring that they pay less than private insurers do), but pharmaceutical benefits for Medicare are provided under Part D, through for-profit insurance companies. Furthermore, it is illegal to use copay assistance from manufacturers for brand-name drugs if you are using Medicare or Medicaid.