[bart_spoon]

Its middlemen. Lilly has been pretty adamant that their revenue per unit has been inline with inflation, despite the sticker price skyrocketing. Presumably that can be fact checked with their financial data. They insist that its PBMs and insurers gaming the rebate system. Unfortunately the rebate system is incredibly opaque and PBMs insist on keeping this way to protect trade secrets.

[RHSeeger]

My understanding is that it's both of them.

- Lilly wants to set the price at, to pick a random number, $100 per bottle.

- PBM says "I need to tell the insurance company I saved them 50%, so you have to charge _my_ client 50% of list price"

- Lilly wants their business, so changes the list price to $200.

- Then Lilly "graciously" lets people without insurance use a coupon to _only_ pay $100 for it.

Everybody gets to pretend they're the good guy. But the insulin costs $5 to make.. so really, they're not (once again, made up numbers).

[srtjstjsj]

The only thing wrong here is a bit of silliness in the structure, the people who do have insurance but don't get the good negotiated price, and your made up numbers