Rebates and incentives are very common when a drug is on patent, but not once it is available as a generic. Insurers have to pay the generics generally and hav

Rebates and incentives are very common when a drug is on patent, but not once it is available as a generic. Insurers have to pay the generics generally and have no rebate for those, though I am sure there are exceptions. Even the article you linked points that out, and a drug like ibuprofen that is generic at this point, has no rebates or incentives, only a negotiated fee on the class of medication generally. When I worked on doing data analytics for one of the large speciality pharmacies a while back, some of their medications had rebates in the low 5 figure range, the medications were typically a low 6 figure prescription. But for the generic meds they carried, there was no rebate and insurance paid the full fair at whatever was negotiated for the class of medications. That was a fun/educational project but also a bit depressing seeing how the system works. The pharmacies are also in this weird middle position where they have to process a lot of the data (and business rules), but can easily get squeezed out of the profit if they aren't savvy. I am with you, destroying the supply chain money antics would be a huge benefit in the US to cutting down the waste and useless spending.