I work for a large mail order pharmacy and I will tell you we make no money on over 90% of our prescriptions. Our margin is less than 4%. The space is hyper competitive and obviously consumers are price sensitive. We are incredibly lean - less than 50 staff to run the pharmacy and a fully robotic dispensing line doing the vast majority of the dispensing.

The drug manufacturers are making massive profits, and nobody is stopping them.

Hilariously the whole TrumpRx card is kind of a step in the right direction, I've screamed for years that manufacturers blatantly rip everyone off and if just use a made up discount card system all of a sudden the drug is 30-90% off.

Ideally the government just says the global price is the US price, and eliminates discount cards entirely.