Example: Imatinib is listed anywhere between $3k and $19k retail depending on the store you buy it (source: GoodRX). With insurance, you would never pay this amount. Without insurance you can use a coupon provider like GoodRX to reduce the retail price to as low as $120. I am told, but have no proof, that if you have no insurance and no coupon, the store will provide a “cash purchase value” that matches or is very close to the coupon price.
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The healthcare industry is corrupt in the US, thanks to insurance companies. The short story is businesses wanted a way to get employees without paying them more. The trick was benefits. By offering insurance as a benefit, you ultimately could pay less as only a small portion of your staff would use it within a given period, and any employee terminated would lose access to that money. Here’s where the corruption comes in – a shared bank account for medical expenses is nice but not profitable. So, the answer was “how can we convince care providers to pay LESS than cost for our subscribers?” The insurance company could take the cost savings and they could boast better coverage getting more subscribers and thus more monthly payments. Of course, care providers aren’t going to just lower prices below cost because someone asked nicely, so they came up with a plan: Jack up the prices for everyone, make subscriber discounts massive, doctors take a loss for subscribers but make up for it from people without insurance. And the icing on the cake – the prices are already so high they can convince people to pay 50% and they’ll gladly take such a great deal, even though the prices are so high, 80% off would be closer to the actual value of the service. Pharmaceuticals eventually took over the same idea – a lot of drugs are sold to pharmacies at one rate, insurance gets you close if not below cost, everyone else pays well above cost but below market cash price even if they use a discount. To balance it out, your insurance and prescription cards won’t give good discounts for every drug – even with insurance you could be expected to pay full price, and GoodRX typically only discounts common doses. For example, if you need a high dose that 20mg@60 taken twice a day would be just as good as 40mg@30 taken once a day but 20mg@30 is the normal, they would be required to fill it as prescribed, sticking you with the single 40mg@30 and it’s excessive cost or ask your doctor to switch and hope they don’t give a nonsense reason not to. Despite being illegal, drug companies incentivize this with perks to doctors because everyone but your makes a profit.
Edit: not pertinent to the question but to add, when a claim is submitted and approved for a service then paid by insurance, they say “you should charge X and we will pay Y” – you don’t have a say in this and it could potentially lead to you still paying well above the actual value of a service. To protect against this, there is nothing preventing you from applying for financial assistance even if you use insurance. If the cost is $100, they charge $1,000, insurance says “We’ll pay $75, bill them $200”, if you present them with “I’ll pay now but I will only pay $100,” they have the option of arguing with you over $100 you insist you’ll refuse to pay, and send it to collections where they have to pay to sell that debt, OR they can take it and still make a $75 profit above the true cost. In most cases, you’ll at worst get “how about we take 20% off?”, at best they’ll say “will that be credit, debit or eft?”
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