Do chain pharmacies bill people without insurance more for the same drug than they charge the insurance companies of people with it? do they negotiate with insurers this way, the same way doctors do?

Insurances: Sometimes that may be the case. It is unfortunate how insurances and manufacturers manage health issues with a market mentality; their focus is not always health care, but plain business. However that is how the system is structured, and every dr wish every patient could afford all necessary medication. Cost is a factor, we often need to adjust, use generic or alternatives our patients can afford.

Yes: Pharmacies pay different amounts for the drugs based upon order volume the same as any other company would. Pharmacies do offer discounts to insurance companies based upon volume and contracts. All brand-name drugs are massively overpriced based upon their cost of manufacture and research cost. Pharmacies probably profit more from generics then brand name drugs.

Opposite: True also: My story: i used to get vit-d 50, 000 u, 4 cap, with co-pay $12.00. I changed my insurance to a better one, next time the same pharmacy charged me $21.00. I asked why so? The pharmacist said "let me do some calculation". Then he said, "doc, give me $15.00". I paid the amount happily, and asked how he brought the co-pay down. He replied with a smile "this is actual price without your insurance".