Purchasing prescription medication is something that many of us have done and nearly all of us will do. Because every day Americans buy many million prescriptions, one would normally think that market forces would push prices down by strong, open competition. This is disturbingly untrue as will be developed shortly.
An example in which the market seems to work largely as expected would be the purchase of a new car. If one were considering the purchase a new car configured exactly the same in 2 separate dealerships, one would expect the prices to be quite similar. If not, the purchaser would go to the lot having the less expensive vehicle.
Interestingly enough, that is not necessarily the case with purchasing the exact same medication at 2 different pharmacies. In the United States, the number 1 prescribed medicine is the generic atorvastatin which serves to lower elevated cholesterol. Lowering cholesterol reduces the number of heart attacks (myocardial infarctions), strokes (cerebral infarctions), obstructed peripheral arteries (and therefore reduces amputations), and so on. It fights atherosclerosis, the number 1 cause of death in the US (cancer is a distant 2nd). In 2021, it was reportedly prescribed 116,700,000 times (according to Statista). In my area (Huntersville, North Carolina), if one does not have a pharmacy plan, CVS will charge $363.65 for atorvastatin 40 mg×90 tablets. If one has a GoodRX coupon, however, this medication can be purchased for $29.35. In other words, CVS will be happy to sell it at a 90% discounted price if you happen to know about the coupons. At the local Publix pharmacy, one will be charged $128 retail with no coupon and $22.25 with the GoodRX coupon. The price at Publix pharmacy (at least at the time this article was written) is roughly 65% cheaper than the price that CVS charges retail. The price of atorvastatin at Publix discounted by a coupon is 25% cheaper still than the price at CVS discounted by a coupon.
Again, please allow me to emphasize that even though both medicines are almost exactly the same (possibly ever so slightly different if made by different manufacturers), the prices are wildly disparate. If the average price paid (including discounted and undiscounted together) was $50 per 90 pills and the actual cost was closer to $10 for the pharmacy (which is conservative), that would mean more than a 400% markup for the average pill. If one were to plug-in $40 per prescription multiplied by 116,700,000 prescriptions=$4.7 billion excess cost for this 1 medication alone (at the current time, I do not have exact figures available but I suspect that this is close). If the purchase of medications were more transparent and the information was readily available to the consumer, this absolute gouging of the consumer-patient might be avoided.