[flukus]

> Prescription drugs. The FDA has a "no existing alternative first" policy - they work on approving drugs for conditions where no current treatment works before they even start considering competitors to existing drugs. This sounds quite logical, but the effect of it is that every new drug is granted a monopoly for a long period of time before any competitor can even legally sell their alternative, so the drug company can literally charge whatever they want.

You think that's government control? Most countries have the government negotiating prices on behalf of it's citizens in a very "take it or leave it" manner. Pharmacists also have to offer a generic if it's available, regardless of what the doctor prescribes.

Those much stronger government controls produce better (cheaper and universal) outcomes.

[oconnor663]

Pharmaceuticals is a tricky example, because the marginal cost of producing them is extremely low. Having the government control negotiate the price of, say, automobiles, might have weirder results.

> Pharmacists also have to offer a generic if it's available, regardless of what the doctor prescribes.

I believe in the US it's actually illegal for a pharmacist to recommend a generic, if the doc didn't check the right box. Maybe just decriminalizing it would have a nice impact :p

[joe5150]

that's backwards. pharmacists are required by health plans or by law in some states to dispense generics (not "offer," dispense, i.e. if I bring in a script written for AMBIEN 10mg, I'm getting zolpidem 10mg without asking) unless the doctor insists on a name brand.

[oconnor663]

I feel like I heard my wrong version in an article about EpiPens. Is it different for devices maybe?

[joe5150]

the first generic EpiPens were just approved a month ago, I don't know if they're widely available yet. if for now some plan formularies only have name-brand injectors on them, some people with insurance could potentially pay less for the brand than the generic until that changes. otherwise, the same substitution allowances and requirements should apply.

EpiPens aren't really medical devices, it's just a drug with a specialized route of administration. it's not any different from an inhaler, a nasal spray bottle, an eyedrop bottle, etc., from a dispensing point of view.

EDIT: it's true that pharmacists aren't always allowed to tell patients when they could save money by buying a generic and paying out of pocket rather than buying a more expensive name brand and paying their share of the full price with insurance. that may be what you heard.