[zbyte64]

Also surprised by the lack of mention of reformulating existing drugs to extend their patents. The poster child of this practice is insulin, where Americans pay absurdly higher amounts for something where generics are abundant.

[vonmoltke]

> Also surprised by the lack of mention of reformulating existing drugs to extend their patents.

Reformulation does not extend patents, it creates a new patent on the new substance. The substance in the existing patent can be manufactured as a generic after the existing patent expires.

The wrinkle is that the new and existing substances are not equivalent, and thus cannot be substituted for one another. Thus, if a doctor prescribes the new one, that is what needs to be dispensed.

[eyko]

Can't a patient ask a doctor to prescribe a generic, when it exists? It seems like that would be an easy fix: a law that requires doctors to give you the alternative name for a generic, and make the sponsored version an optional upgrade.

I'm European and the whole concept of a doctor prescribing a "brand" sounds alien to me.

[vonmoltke]

> Can't a patient ask a doctor to prescribe a generic, when it exists.

Yes, but it requires the patient (or their pharmacist) to request such.

> It seems like that would be an easy fix: a law that requires doctors to give you the alternative name for a generic, and make the sponsored version an optional upgrade.

> I'm European and the whole concept of a doctor prescribing a "brand" sounds alien to me.

The issue is that the two drugs are not equivalent, and is not about prescribing a "brand". Occasionally, a doctor insists on the brand for some reason (seems to be most common with Synthroid for some reason), but generally the prescription is treated as a prescription for the compound, even if the doctor uses a brand name.

The trouble with reformulation patents is that there is no generic for the reformulated compound. It is sufficiently different from the previous that it cannot be substituted by the pharmacist (otherwise it wouldn't have been patentable). In that case, the "brand" is the only thing available.

[bluGill]

To be fair, reformulation isn't exactly cheap (though compared to a new drug it is), and often they are better than the generic. Generic insulin still exists, but the reformulations are better - or so the diabetics I've heard from have said.