In addition you are comparing somebody who has insurance (slovenia) to somebody who theoretically doesn't 'US'. Most people in the US get their health insurance through their employer and would pay nothing out of pocket, and if you are uninsuranced the drug companies will often times just give the drug away to you for free.

Even if you have really good health insurance, you often pay out of pocket.

> if you are uninsuranced the drug companies will often times just give the drug away to you for free.

This is horribly incorrect. People die for lack of insulin in the US all the time, and it's not because they just didn't bother to ask for their free insulin.

No, I´m not. The price for an insured patient (which is everyone, by law) is zero. 19.96 is just the sticker price.

But they have 'insurance' through their taxes.

The "cash" price is $342. The $142 is from a $200 which has eligibility requirements, which don't allow you to get that discount in many cases.

What requirements are attached to using the PBM replacements? My understanding is that you go to a pharmacy that accepts them and give them a number to put into the computer.

Or does using them disqualify people from other programs?

I may have slightly overstated the case above (and have now edited my language to be softer) because frankly, a lot of stuff said in this thread is extremely upsetting to me. (Not you, you are one of the more reasonable people here.) I don't actually know what the numbers are, strictly speaking. In my experience, a lot of things around this sound reasonable until you actually have to come into contact with the bureaucracy surrounding them, and they end up being much more onerous in practice.

But yes, if you click on the green button, you'll see a list of restrictions. One of those is that if you're participating in any other state or federally funded programs, yes.

The "I have been prescribed this drug" bit is also pernicious; you don't get a prescription for "insulin," you get one for Humalog or Novolog or Levemir. You are at the whim of your doctor. Used one kind for years, but suddenly lose your job, which means a change in health insurance and a change of doctor, who decides that you need to change your brand for whatever reason? You can't use this discount to help keep continuity. (Additionally I am not sure what the "or am a caregiver" requirement is legally, but should really look that one up so that I know exactly what those requirements are, so thank you for giving me something to do today...)

Thanks for pointing that out. GoodRx is not available from EU (Either due to GDPR or due to not being applicable to non-US readers, I guess). That invalidates my numbers a bit.

However, it´s also pointing to another facet of this issue: the opaqueness of the pricing. In here, price of medication (including insulin) is regulated and it´s the same everywhere, for everyone and no seller-specific discount can be applied.

Yeah, they make money by working the convoluted US system.

It isn't good that the prices vary, but it's been long enough that people with substantial drug costs should be doing some basic checks, discussing the highest quoted US prices doesn't reflect what people are paying.