Drug Pricing: What You Pay and Why It’s So Unfair

When you walk into a pharmacy and see a $600 bill for a month’s supply of a pill your doctor prescribed, you’re not imagining things. Drug pricing, the cost set by manufacturers, pharmacies, and insurers for prescription medications. Also known as prescription drug costs, it’s one of the most confusing and frustrating parts of modern healthcare. Unlike other countries where governments negotiate prices, the U.S. lets drug companies set their own rates—with little oversight. That’s why a drug like insulin can cost $30 in Canada but $300 here. It’s not about production. It’s about control.

Behind every price tag is a system built on generic drugs, lower-cost versions of brand-name medicines approved by the FDA. Also known as brand equivalents, they’re supposed to save you money—but even generics aren’t always cheap. Some have seen price hikes of over 1,000% in just a few years. Then there’s Medicare Part D, the federal program that helps seniors pay for prescriptions. Also known as prescription drug coverage, it’s full of gaps, tiered costs, and coverage cliffs that leave people choosing between food and medicine. You might think your insurance covers you, but copays, deductibles, and formulary changes can turn a $20 pill into a $200 one overnight. And if you need a specialty drug? Forget it. Some cost over $10,000 a month, and even with insurance, you’re stuck with thousands in out-of-pocket fees.

It’s not just about big pharma. The system rewards secrecy. Pharmacy benefit managers (PBMs) negotiate rebates behind closed doors, and those savings rarely reach you. Tier exceptions—like the ones covered in our posts—can lower your costs, but most people don’t know they exist. And when hospitals run out of injectable drugs because manufacturers can’t keep up or won’t make them profitably, it’s not a supply chain issue. It’s a pricing issue. If a drug doesn’t make enough money, it disappears.

What you’ll find below isn’t theory. It’s real-world fixes. How to use tier exceptions to slash your copays. Why some generic drugs cost more than the brand. What to do when your insulin price jumps. How Medicare Part D plans hide the real cost. And how contamination controls, therapeutic equivalence codes, and even herbal supplements tie into the bigger picture of what you pay—and why you shouldn’t have to pay so much.