Yup. This price is at least partially distorted by the fact that she can’t just go buy the cream without getting a prescription first. That means tight control over distribution, meaning huge barriers to entry and being forced to play ball with this insurance system when someone does enter.

There’s no way for the market to create that simple channel from this medicine to those who need it at the natural market price which is quite low.

All these elements that aren’t naturally required, but are required by law to be part of the deal, cause the price to get weird.