By far, these are the most corrupt organizations in the medical/drug industry. At least the phrama companies actually make something at the end of the day and do research, and employ more than just business people. I am forced by whatever insurance plan I have, to deal with these companies directly because they have whats called a "carve out" -- an exclusive agreement with the major insurance carriers that requires I deal with them directly. I literally have no choice or alternative from which to get my medication.
The reason is clear: my medication costs between $60,000 - $150,000 per month. I'm not kidding, either. It's been this way forever, despite the patents expiring on the medication. Its so lucrative and it makes me ill that so many people are benefiting and using me as some kind of financial conduit due to my medical condition. A significant amount of the money goes to one of these companies. They literally have a markup on the medication on a per-unit basis. So they tack on 20% or 30% to each unit of my medication (think pills, but its actually IU potency units -- its an IV medication I give to myself).
I'm fortunate that, because of these extreme costs, these companies have actually worked out in my favor: they have a dedicated rep assigned to me, and continually renegotiate their position with the insurance carriers to maximize their profit (I'm a high-profit user and thus very important to them).
These companies have no interest in getting costs down, and actually fight for the opposite. A few years ago they bullied the drug companies into offering a co-pay assistance program so they can literally take my insurance for all its worth. Their goal is to max out whatever benefits I have, and at that point usually the patient can be a blocker because they don't have the money for the maximum yearly deductible. However, they basically worked with/forced the drug companies into creating a co-pay program, then raised up the prices for the first order of the year. What happens is the first order I place is always more expensive, and then it gets discounted by some amount (usually my yearly co-pay). I don't have to pay this money however, it comes directly from the manufacture's co-pay assistance program.
So I guess its a triumph in the fact I don't really have to pay much -- if anything for my medication, but that's only because its extreme high price. I'm sure its not like this for other people on the middle and lower ends of the system.