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Comment by jancsika | Hacker News Reader

> Over time, Big Pharma learned how to game the law. As the patent for the original drug approached expiration, companies added wrinkles — a new coating for the pill, a time-release version, and so on — that they then patented. If the patents were approved, and they usually were, the exclusivity clock would start ticking all over again.

I don't understand how that would ever work.

Time-release version of X, now with new coating: patented

Old version of X, with no time-release and without new coating: patented expired, correct?

If so, what stops the generic manufacturer from just manufacturing the old version of X?

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There is nothing to stop them. The only reason why "evergreening" works is because doctor's write scripts for the "new" drug.

Sometimes it's worth it! If you need to take a drug three times a day and the new version is only once, that can improve patient adherence and outcomes.

However, sometimes the added value is minuscule. In that case insurance companies should just say "we're not paying for it since the added cost is not worth it".

Problem solved.

> Sometimes it's worth it! If you need to take a drug three times a day and the new version is only once, that can improve patient adherence and outcomes.

For the moment, let's ignore that case by simply calling the improved drug a new drug.

> However, sometimes the added value is minuscule. In that case insurance companies should just say "we're not paying for it since the added cost is not worth it".

I'm still lost.

1. Doctor writes prescription for "B", which is really "A" with an insignificant change and a price bump.

2. Patient goes to pharmacy and looks at their copay for "B." Whoa! they say-- that is surprisingly high.

Wouldn't the pharmacist then have the responsibility to jump in with their expertise at this point? Say: "B" is just a slightly altered "A" to get you to pay more, so call your doctor and ask them if you can take "A."

The pharmacist should do that, but they don't.

I've done it before at a doctor. "Here is the latest drug!!". "Can we start with a generic?", "Sure".

My co-pay just went from $50 per month to $5.

I work with a lot of doctors, they don't think it's their job to save patients money. They'll do it if asked though.

I find that kind of astounding. In the UK you pay a flat fee per prescribed medication, and multiple times I've had doctors prescribe me larger amounts on my repeat prescriptions so that I have to pay the flat fee less often - completely unprompted by me.

Docs will do that in the US too sometimes, but one challenge is that the "fee" you owe with private insurance differs from plan to plan. Doctors can't track the hundreds of different plans, so they don't know if the more expensive branded drug will cost you $10 more per month or $100 more per month. If you share that info with your doctor they are more than happy to work with you.

I'm still confused.

Isn't it simply a matter of asking, "Is there a generic for this, doc?"

Both $10 and $100 are greater than $0, the patient almost certainly always wants $0, and a doctor can do that math without referring to your plan.

Or is this a case of this particular method being combined with N other methods such that the doctor has trouble getting the correct information to the patient?

Edit: By $0 I mean "$0 more than the cheapest generic." :)

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