It’s not the pharmacies that set the prices. At least, not really. The pharmacy pays near the listed “cash-price” for the drug from the wholesaler, who buys from the manufacturer, so the pharmacy can’t really afford to charge much less than they do for many drugs.

And the price the patient sees after insurance is decided based on the insurance or pharmacy benefit manager who deals with prescription benefits for the insurance.

Pharmacies are also contractually prevented from charging less to a cash-paying patient than what they charge to the insurance companies, so you start getting weirdness with coupon cards to work around that.