A pill that costs $47 to make can sell for almost $10,000 at the pharmacy counter. Legally. Every day.
It's a generic cancer drug called imatinib. Cost Plus sells the exact same pills for $59. Same molecule, same factory, same FDA approval.
So where does the other $9,900 go?
Three companies decide what your prescription costs: CVS Caremark, Express Scripts, and OptumRx. Together they run roughly 80% of US prescription claims. They're pharmacy benefit managers, and their core move is spread pricing: bill the insurer one number, pay the pharmacy a lower number, pocket the gap. The price on the label reflects what they can extract before anyone questions it, not what the pill cost to make.
imatinib is one drug. The same spread sits inside thousands of generics.
That only works while the real cost stays buried. The whole retail system is engineered so you never see the manufacturer's price, the markup, or who took which cut.
Cost Plus didn't unlock a secret supplier discount. Read the formula on the site: manufacturer cost, plus 15%, plus a $5 pharmacy fee, plus $5 shipping. That line is the entire company. They print the receipt the rest of the industry spends billions keeping sealed.
Which is why a $50 gap could push a man to ration cancer treatment. He was paying for the opacity itself, a charge the system collects from whoever has the least power to ask what anything actually costs.
katsu (@katsuxbt)
Mark Cuban says a man with cancer stopped taking his meds so he wouldn’t leave his family in debt, the drug cost $93 but his pharmacy sells it for $43, a $50 gap was deciding whether he lived
“We’ve been able to save people. I mean, literally people will walk up to me on the street and hug me or start crying or send emails”
“My dad has cancer and he didn’t want to saddle us with credit card debt when he died. So he decided not to take his medications anymore”
But then we went to costplusdrugsdotcom and instead of being $93 that we can’t afford, it was $43 which we could afford. Life changing”
Video
— https://nitter.net/katsuxbt/status/2068653287583166626#m