https://publichealth.jhu.edu/2023/eli-lilly-lowers-insulin-p...

> “Even though they're dropping their list price by 70% and capping their cost to patients at $35, it’s important for us to make this very, very clear—the company is still making a profit,”

...

> During a 2019 congressional hearing, insulin makers admitted that there’s pressure to keep list prices high so that PBMs can also profit.

> PBMs favor the drugs that will yield them higher profits. By lowering prices, Lilly runs the risk of being excluded from formularies, meaning the insurance companies will no longer cover the product for their patients.

Are you actually serious? Practically all generic drugs are available because the original drug is off-patent. You picked one (insulin) and ignore, oh, take Alprazolam :

https://www.drugs.com/alprazolam.html generic for Xanax.

or all the others:

https://www.healthgrades.com/right-care/patient-advocate/dru...

From the page you linked:

> While these drugs are nearing the end of their patent term, the release of generics may be delayed due to litigation, acquisitions, or other exclusivities. As a result, some expected generics from previous years may still be in progress.

The point about the PBMs is that apparently, drugs have to be profitable or they are not made anymore. So even the generic companies need to position themselves in a way where their products are profitable, not only for them but for the insurance (or they will be dropped by formularies, and nobody's insurance will cover it.)

If patents are the only way for firms to protect the profitability of their drugs then we are doomed.

I picked one, sure, and you provided a list as counter-example. But the FDA also ships its own list... of off-patent approved drugs without an approved generic (and the current publication is a full 16 pages of drug names):

https://www.fda.gov/drugs/abbreviated-new-drug-application-a...

If the pharma companies can make a change to the formula so that the new formula of a drug is no longer covered by the original patent, they can get a new patent. I'm not an expert, but this is how I've understood the problem through reading about it. Yes, we have generics, but what doctor will prescribe "worse-pirin" when there's a better aspirin on the market now? What insurance company will cover it?

So, with 20 years of head start and a deep war chest, the companies you mentioned can all iterate, stop research on the previous drug, put up legal roadblocks in the way of their competition, put out a new drug which cannot be copied, while it costs a lot of money for competition to get their generic form of the drug tested and approved. It's not as automatic as the term "patent cliff" might suggest.

I'm just saying that the intent of patents in general is for innovations to enter the public domain after the period of exclusivity on the idea that enables their creators to enjoy profitability and a legally protected (temporary) monopoly on the idea. It seems like a fair question to ask, is that really what's happening? (What percent of time does it happen like that, what percent of time does it go down some other way?)

I never said they did. However, there are giant companies that do almost nothing but generics, like Teva, so obviously lots of generics exist:

https://www.tevapharm.com/our-company/teva-facts-figures/

As for "what doctor will prescribe "worse-pirin" when there's a better aspirin on the market now? What insurance company will cover it?"

nearly all insurance companies require a generic to be used unless there's a very strong reason to use the branded product. In your example, if the new drug genuinely is better, then the patients deserve to have it. If it's a trivial improvement then it won't get approved.

This is an extremely disingenuous reading of our conversation. I made a specific statement about a particular instance (which you dismissed as cherry-picking), and I asked a question at the same time. Which you reduced overall to a "general statement" while dismissing the specific example that was really important to the context of what point I was trying to make:

> James Collip and Charles Best [donated] the insulin patent "so that everyone could have it" and we still don't have universal low-cost insulin over 100 years later, and prices continue to skyrocket

> Is there any evidence that drug patents can actually enter the public domain productively at their end of their expiration period?

There's an impedance mismatch between "nearly all insurance companies require a generic to be used" and "drug patents should be clearly in the public interest" when "drugs have to be profitable or they are not made by companies anymore."

Why not engage a bit more directly with the original example, if you're going to accuse me of generalizing now? Let's talk about insulin, I'm sure I picked it for a reason.

Is there a generic insulin that is chemically identical to a name brand insulin with the same efficacy? No, there apparently is not [1] – I won't claim to be fully informed on these issues, but it seems pretty clear from reading that the issue cannot simply be reduced to "lots of generics exist, so you are mistaken."

Why can't we have low cost insulin from an entity that operates like the post office, that exists as a public benefit corporation without any profit motive?

Does it really make sense that people who have insurance that is not "top tier" will not have access to the better (still patented) drugs, if they are really better? Are they better, or are they really just "evergreening" patents? If insurance typically only covers generics, then it's really problematic that there is no generic form of this lifesaving drug, and the monopoly persists more than 80 years after the patent should have expired on the original invention!

The deal was supposed to be 20 years. What went wrong, does it "go wrong" a lot, and does it "go wrong" more or less frequently when human lives are at stake? These aren't unfair questions, and if Teva (or any company other than Eli Lilly) made a generic form of Humalog insulin then I probably would not ask them at all. But only Eli Lilly does, only Eli Lilly can.

The same company apparently makes the so-called "generic" insulin that also makes the top-tier patented "Humalog" so maybe there are too many regulatory hurdles or something else is wrong. (I thought that the generics were supposed to represent the competition, that comes to save the day after patents expire...)

If we're central planning, wouldn't we want to promote a resource arrangement such that the best drugs with the most promise and the greatest life-saving properties will go to the most people? Is it really so off-base to conjecture that a resource arrangement that actively does something else is "really evil?"

[1]: https://www.healthline.com/diabetesmine/why-is-there-no-gene...

How is it "disingenuous" to quote that? I'm not "accusing you of generalizing" -- you did it.

I don't care to engage with you about insulin or indeed drug patents in general. Just say what you actually mean.

I put it back there because that was the context that I felt was most important, and you just cut it right back out again. You're not arguing in good faith at all.

"...because it's an argument in bad faith? I too don't see why drug patents are "obvious" or clear case that it is helpful enough to be in the public interest to maintain drug patents. Is there any evidence that ALL drug patents actually enter the public domain productively at their end of their expiration period?" [note the ALL]

Since you refuse to just admit you were wrong, we are done here. Go ahead and have the last word if that's important to you. I won't be replying any more.