Americans tremble at the idea of losing their health coverage, but bypassing giant insurers saves some people serious money on prescriptions in a topsy-turvy system.

Consider the story of Ohio pharmacist Nate Hux. Since 2016, his Pickerington Pharmacy has accepted many types of insurance. But, due to his frustration with the way middlemen, known as pharmacy-benefit managers, pocket large profits through opaque pricing methods, he decided to open another pharmacy right next door that takes no insurance. It sells generic drugs for their cost plus a markup, sometimes saving customers hundreds of dollars.