"Prescription drug prices are out of control"

That's not news, of course.  But a longread at PhillyMag provides some insight into the bureaucracy and some ideas.

I’m on drugs for multiple sclerosis and have been since 2004. MS meds are what are called maintenance drugs, meaning you take them daily or weekly from the moment of diagnosis till death or untenable side effects do you part. They’re also some of the most jaw-droppingly expensive drugs on the market. Today, in 2019, the four different name-brand medications I’ve been prescribed at different points in my treatment list for between $75,816 and $98,899. Per year. Prices are indeed high. And they’re going up fast.

Like everyone else, I’d been hearing the drumbeat: The cost of prescription drugs was out of control. But because the insurance plans I’ve been on had decent-enough prescription drug coverage — my meds had generally cost me a co-pay in the $100-to-$150-per-month range — I’d been shielded from the issue. And a few years back, I discovered that if you ask, some drug manufacturers will actually pay your co-pays for you. So I was getting drugs that listed for a decent annual salary for the cost of my modest-by-comparison health-insurance premiums. I didn’t know who was paying how much of those prices — honestly, they seemed too absurd to be real. All I knew was that it wasn’t me.

But as I sat in the conference room for my company’s annual benefits presentation last December, I got a cold dose of reality — and became another of the millions of Americans incensed by the skyrocketing prices pharmaceutical companies charge for their products and the byzantine, competition-squelching health-care system that allows those prices to escalate unchecked...

Thanks to secret negotiations, the prices that pharmaceutical companies list are different from the prices for your insurance company, which are different from the prices for your pharmacy. America’s health-care system is the most expensive and pointlessly complicated in the world...

Fact 7: Nobody outside of this system knows what’s happening inside of it. And the fact that we know so little suggests that it’s in the best interests of all involved to keep quiet.

Fact 8: Pharmaceutical companies claim, rightly, that developing drugs is an expensive business, and that for every drug that eventually makes it to market, there are untold failures.

Fact 9: And yet we also know that pharmaceutical companies are some of the most profitable businesses on the planet...

Fact 10: As a result, everything happens in a black box, and as any NTSB investigator will tell you, nothing good comes out of black boxes. The whole system is a vicious circle of plausible deniability. In the face of criticism, any one entity in the supply chain can, and often will, point to the others and say, essentially, “Not it.”

Way more at PhillyMag.