[unclenoriega]

That's not really how it works with drug prices in the US. I don't know exactly how it works behind the scenes, but from the pharmacy perspective, it's basically like this:

The "sticker price" of a drug is called the "usual and customary price" (U&C). This is supposed to be what you charge for a drug, and is generally based on the "average wholesale price" (AWP) of the drug plus a dispensing fee to cover other costs. The AWP, however, may or may not (usually not in the case of generic drugs) be related to the actual acquisition cost of the drug. It tends to be substantially higher.

The pharmacy bills its U&C price to the insurance company (or, more often, a pharmacy benefit manager (PBM) contracted by the insurance company), and the insurance company tells you what it will actually pay you—this can be negative—and how much to charge the patient. Usually the pharmacy gets paid whatever the insurance company/PBM thinks it should cost to fill the prescription, and the patient pays a standard copay/coinsurance. If the patient has a large deductible or doesn't have insurance, this is where GoodRx et al. come in. They act as a PBM, allowing the patient to pay a price lower than the U&C while pocketing ~$5 or so of the "copay" for themselves (plus whatever data they get). Often independent pharmacies will just cut out the middle man and give you a better cash price (although this may violate their PBM contracts), but the big chains will need the coupon.

Depending on the difference between the AWP and the actual acquisition cost of the drug(s), this can be a substantial savings for cash patients or people with large deductibles.

[ericmay]

Sorry, I’m not sure what you mean here with “that’s not how it works”. Could you explain?

-edit-

I guess what I mean to say here is I'm not commenting on how drug prices work. It doesn't matter. I am commenting on the fact that somebody, somewhere has to pay for the drug, regardless of the price. I want to push back on this idea that drugs are "free" in Europe or elsewhere. Sure the healthcare programs appear to be better managed, higher taxes on the wealthy or corporations (although I don't know for sure) appear to be subsidizing costs for lower and middle classes, but the drugs still aren't free in any sense of the word to the society as a whole.

[unclenoriega]

I was trying to trying to point out the scale of the "inefficiencies" inherent in current pharmacy billing practices (and in my understanding medical billing in general). The prices are literally just made up[0], and then payors have to guess how much they should pay. "That's not how it works", perhaps a poor choice of words was intended to reflect that if a drug costs $2000 per month or even $500/month, often that money doesn't need to come from anywhere.

Now that you've clarified, it sounds like you're arguing against the idea that drugs have no cost of development or production, which is not an idea that anyone actually holds, so I'm sorry for wasting our time. I would point that "free at the point of service" does seem to be one sense of "free".

[0] https://www.rjhealth.com/2019/07/31/drug-pricing-101-reimbur...

[ericmay]

> I would point that "free at the point of service" does seem to be one sense of "free".

Sure, and my contention (going back to the grandparent) is that is an illusion. I'd be more than happy to give you a car for free and then just charge you later if you thought you were getting it for free. I want people to continue to be aware that even drugs that are sensibly priced do still bear costs to society.

> which is not an idea that anyone actually holds

You'd be surprised. In fact, the language most people use is "healthcare is free in Europe and elsewhere" because they don't understand how things work. It's not free. Never has been and never will be.

> often that money doesn't need to come from anywhere.

I'd love to hear more. How is it that nobody has to pay for the drug? How does the drug come into existence without money?

[int_19h]

They're saying that most of the price of the drug is way in excess of the actual costs involved. So the only reason why anyone is paying that much is because somebody is trying to collect significant economic rents from their drug purchases. In a not-for-profit healthcare system, or one where drug prices are regulated, this overhead would simply not exist.