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It's the Pharmacy Benefit Managers. From what I understand they usually get paid based on percentages (in complicated ways). They negotiate between the pharmacy, insurance companies, and the drug manufacturers. So the more the drugs cost the more money they make. Pharmacies all over the country are losing significant money on every name brand drug they dispense because it costs so much to buy and the reimbursement or coupons don't cover the loss. They only turn a profit off of generics. But if you lose 50 - 100 bucks (yes they are somtimes losing that much!) dispensing a bottle of name brand and only make a 5 dollar profit off a bottle of generics then you have to sell a crap ton of generics to make up for it. PBMs want the drugs to cost a lot so they cost a lot.