Pharma has a bogus number called Average Wholesale Price (AWP), which is an amorphous number that changes at their whim. This number is discounted to providers on what they pay which determines their costs after co-pays. The end user of the prescriptions never know the real cost to their insurance for the drugs they take because they see the co-pay and may never look at the explanation of benefits (EOB). Wholesales such as McKesson, Amerisource, etc. all screw with the numbers to make it impossible to know the true cost of the drugs.
If we want real reform in pharma, the FDA and FTC should require a "stated price" for every branded and generic drug from the manufacturers themselves. The known price should not be different for CVS, Rite-aid, Walgreens or Walmart, SEIU, Teamsters, etc. regardless of wholesaler. Wholesalers can then set their prices and base contracts on what they are willing to charge.
The manufactured price should be the stated price regardless of insurance. The providers can then negotiate from a real number. Medicare and Medicaid can negotiate for pricing based on their amazing volumes instead of having some amorphous number that overcharges the taxpayer to benefit the manufacturers and wholesalers by hidden figure numbers games.
As with many private plans, Medicare and Medicaid should require generics when available. A 90 day supply at $180 for a brand ($30 co-pay in private plans) can cost as little as $30 for a generic ($10 co-pay in private plans). Let market forces protect the taxpayer.