Several people have raised the point that if the discounts are automatic why not just change the pricing? Pharmaceutical pricing and a lot of healthcare pricing

Several people have raised the point that if the discounts are automatic why not just change the pricing? Pharmaceutical pricing and a lot of healthcare pricing in general are strange in the sense that they are organized to capture what certain plans/institutions will pay. If there is a plan out there that says "we will pay $540 for a month of lifesaviex" you are going to see prices at $540 or above to capture that even if in other contexts some patients are getting it at $35 a month. There is a lot to potentially discuss about that but cherry picking one interesting thing... Many very large employer plans are administrated by the insurance companies names you are familiar with, Anthem, United, etc. However the details of the plan, including reimbursements, are actually set by people at the employer, not the plan. There is someone in the giant beauracracy at these companies who compiles/edits/approves a massive spreadsheet and out into the market it goes. Mistakes are common. In a similar vein, some poorly thought out reimbursement rate setting by CMS/HHS related to drug testing wasted at least 216 million dollars. A virtual cottage industry sprung up around it while it was in effect. It was not an isolated incident. https://oig.hhs.gov/oas/reports/region9/92103006.pdf https://oig.hhs.gov/oas/reports/region9/92103006.pdf