I don't think there is a simple explanation, that's why I used the word "morass".
"From when insulin is produced by the drug manufacturer to when it goes to a pharmacy, profit is extracted at every step of the way. The insulin market is dominated by three large drug manufacturers—Eli Lilly, Sanofi, and Novo Nordisk—that, with little competition, have raised their list prices in lockstep. But there are other players besides the Big Three that are contributing to the problem. Pharmacy benefit managers, or PBMs, contract with insurance carriers and act on behalf of the insurer to negotiate the price of insulin with the drug manufacturers. In negotiating the price, PBMs place a drug higher or lower on their tier of preferred drugs and receive rebates based on a percentage of the list price. This kind of system incentivizes high list prices, which determine the amount of co-insurance patients pay. And if patients have a high deductible or are uninsured, they might pay the entire list price."
"From when insulin is produced by the drug manufacturer to when it goes to a pharmacy, profit is extracted at every step of the way. The insulin market is dominated by three large drug manufacturers—Eli Lilly, Sanofi, and Novo Nordisk—that, with little competition, have raised their list prices in lockstep. But there are other players besides the Big Three that are contributing to the problem. Pharmacy benefit managers, or PBMs, contract with insurance carriers and act on behalf of the insurer to negotiate the price of insulin with the drug manufacturers. In negotiating the price, PBMs place a drug higher or lower on their tier of preferred drugs and receive rebates based on a percentage of the list price. This kind of system incentivizes high list prices, which determine the amount of co-insurance patients pay. And if patients have a high deductible or are uninsured, they might pay the entire list price."
https://medicine.yale.edu/news-article/the-price-of-insulin-...
My position is simply that it is better to solve problems by taking regulations away than piling them on.