[maxerickson]

The cash price will often be lower than the copay (which isn't a good thing, but it signals that the issue is benefit design rather than cost of provision).

For example, Walmart sells a month supply of levothyroxine for $4 if you don't get your PBM involved.

[nikolay]

Yeah, but Walmart generics are made in India by companies known for recalls due to carcinogen contamination. Not that recalls in Europe don't happen, but I'd rather purchase from a pharmaceutical company in business from the 19th century. If US regulators believe that India has more stringent pharmaceutical standards than Germany, then something is fishy! And there's so much corruption in generics [0]!

[0]: https://www.washingtonpost.com/business/2023/04/04/big-pharm...