[ch4s3]

Not really. They're highly regulated in their offerings, and the government mandates how much they spend on care vs. overhead. They can't effectively compete so the only option is to negotiate slightly higher payments to providers and PBMs every year so they can take more profit in absolute terms.

[treis]

Either prices are in their control and one company can gain market share by lowering them. Or they're not. I don't think you can have it both ways.

[ch4s3]

It can be a one way ratchet, which is my argument here. Regulations, medicare rates, and pricing power from drug companies set a floor for prices. Insurance companies already run pretty lean and have so-so margins. The 80-20 rule incentivizes a slow ratchet up on prices and the other factors prevent competition on price. The system is designed to have slow predictable price increases.