I was planning to write a longer post for this mega and then Silksong happened so... oops?
Short version is this week is my 9th tranniversary. I don't remember which day exactly so I like to say it was 9/11 so I'd never forget. What ultimately cracked my egg all those years ago was not the deep yearning when looking at women that I couldn't identify as envy or the increasingly intense and umm horny dreams where I had the power to instantly change my gender. No it was that fucking faceapp gender swap filter. I just kept staring at that pic like it was a mirror into an alternate universe where I was happier and suddenly everything clicked into place. The first few years were hit or miss with a lot of other life changes happening at the time that interfered with getting properly started so in some ways it's more like a 5 or 6 year tranniversary but whatever. 
It's weird to say I'm almost done but I really am so close to making all the changes I wanted. I'll never stop being trans, but I'm definitely moving from trans(itioning) femme to trans(itioned) femme and that's quite exciting. And maybe a little wistful looking back at the journey.
Have a good week everyone!
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Pharmacy Benefit Managers (separate from, but mostly vertically integrated with, insurance companies in the US) absolutely have been doing this for years now. It lets them say they're providing a service and reducing prices when they're doing the opposite.
Without getting into the details, the cash price of drug x gets set obscenely high, pharmacies bill this price to the appropriate Pharmacy Benefit Manager who then tells the pharmacy "we're paying you whatever we pay you". By and large you're lucky to break even. For some medications and some contracts it can cost a pharmacy hundreds of dollars to fill a prescription. You're not allowed not to fill it. You're not allowed to charge the patient less than the cash price you charge everyone, which is the inflated number the PBMs conspired to come up with. If you do, you risk losing even more money getting audited by Optum or Express Scripts and good luck with that lol lmao
That's the short/comprehensible version. A 30 count bottle of ondansetron (generic Zofran, nausea med) costs $0.39 or so but the U&C most pharmacies use for billing purposes is >$1,000/30 tabs. Actual reimbursement for #30 ondansetron looks more like $0.39 + maybe a dispensing fee that doesn't cover the cost of keeping the lights on. That U&C also becomes the cash price without goodRx or one of the other middlemen who aggregate PBM data and pick a price more or less at random from what reimbursements actually look like. GoodRx also bills pharmacies $8 for the privilege of checking a price with them, every time you submit them a claim.
It's fucked. There's compounding pharmacies that'll make injectables for you cheaper than you can find at a standard retail pharmacy, if you can find one.