Make it make sense.

The price was bullshit to begin with. The cream probably sells over the counter for about $2.50 so OP still ended up paying 10x the price.

Its a tax scheme.

The pharmacy claims this medication is worth $275, insurance covers $40, and then they get as much as they can out of the patient while claiming the rest as a loss they can write off on their taxes.

US healthcare is stupid.