Just had this discussion with a co-worker that is taking brand-name Humira - and AbbVie does exactly this, they coupon his out of pocket to his deductible limit and then he pays nothing. The rest of us in the risk pool of course then carry the ~$4K/month cost and nobody in the food chain pushes back, because they are incented to do the opposite. The result is 2017 sales for Humira of $18.43 billion dollars, 2/3rds of which was US. This is just one drug that the US healthcare insurance participant is carrying pharmaceutical profits for.