I was always under the impression that it was a combination of the patent system (delays generics), the lengthy drug approval process, and doctors having loyalt

I was always under the impression that it was a combination of the patent system (delays generics), the lengthy drug approval process, and doctors having loyalty to a particular drug brand (I don't know if this is a thing). I wonder if cutting patent durations (say 5 years) while also reducing FDA approval times (say by allowing human trials earlier with a waiver) would maintain innovation while reducing costs. For the doctor brand loyalty thing (or maybe it's patients asking about ads), one thing I find particularly interesting is insulin. There are several options that are much less expensive than their competitors, but doctors seem to push the more expensive options. Yes, the more expensive options are better in certain ways, but the less expensive options still work fine. Since I don't have diabetes, I don't know the whole situation, but I'd like to also have some figures for insurance coverage and costs the customer sees vs patient loyalty to specific brands/types of insulin and whether they're aware of less expensive options. I think it would be an interesting case study that may generalize to other types of drugs.