The variation in pricing is amazing. but not surprising considering how little transparency there is in an arena where insurance often blocks a clear view. On a micro scale, I had a minor mouth irritation that a doc precribed a generic lidocaine solution for. They wanted to fax it to the pharmacy of my choice but since I apy out of pocket, I asked for a generic script and shoppped around. A few phone calls revealed I could pay up to 4x the cost of the lowest available price. This happens most of the time I need something and shop around. I have never seen an over the counter medication range to such multiples, presumably because people are aware what it should cost. There are also instances where a long term medication can be significantly less expensive if a larger amount is purchased. Pharmacists aren't likely to mention this unless asked.
In the cancer treatment arena, I wonder if variances in cost end up influencing treatment decisions at the doctor or patient level. If someone is going to get multiple rounds of Herceptin, could a case of it (or contract) be purchased at a discount? I just posted an article about perversions in the coverage of oral vs IV therapies:
http://her2support.org/vbulletin/showthread.php?t=41199
Whether within private or government health care coverage, hidden cost perversions can lead to invisible rationing...not so invisible when a copay makes you think twice.