[james1071]

I haven't read beyond the first page, but do know a bit about the US drug industry.

Briefly, since the late 1980s, the market for prescription drugs has evolved from one where pricing was close to list price, to one where pretty much everyone gets a large discount.

(By everyone I mean any kind of insurer or bulk buyer)

The effect is that the market has become completely lacking in transparency, as the discounts are not public.

Also, in many cases, the discounts end up in the hands of middle men, such as Pharmacy Benefit Managers or Insurers.

That suits them very nicely, as these discounts account for a large part of their profit and are hidden, unlike their premiums and insurance plans.