Through insurance plans, the actual cost to the patient may be lower. However, when patients are responsible for a larger share of the costs, they are less likely to use the healthcare service (Mattingly). Overall these insurers are at a loss because they have to cover the cost of the drug or fight for a discount (Pollack). Insurers can increase the cost of their insurance or limit the coverage of their plans by using co-payments or increasing deductibles. Considering who covers the costs of these drugs, if Medicaid pays, it is a major blow to state budgets, and the money comes from taxpayer dollars (Pollack). This threatens the fiscal sustainability of healthcare. Overall, the convoluted drug cost structure demonstrates that rising prices are due to a number of factors. By focusing on cost minimization, manufacturers should be able to cover research and development costs while still charging a reasonable price. By focusing efforts on setting prices that are attractive to both consumers and consumers