It's actually a pretty clever scheme by drug companies to foist the cost of medicine development AND supplying uninsured people onto insurance companies (and from there, the cost is passed on to people with insurance). I just don't understand how it's legal, or why the insurance companies - who are supposed to have such great collective bargaining power - accept this status quo.

I have noticed that it only seems to happen with very expensive, very recently developed drugs which are not yet part of the insurance companies recommended therapies, and they typically require a prior authorization (special approval based on the doctor stating there is a medical necessity for this, and only this, drug).