Both of the drugs listed in the article (Remicade and Entyvio) have generic/biosimilar equivalents, too, so in theory competition should drive down the price...

Both of the drugs listed in the article (Remicade and Entyvio) have generic/biosimilar equivalents, too, so in theory competition should drive down the price... but this is the American healthcare system so of course it doesn't. Unclear from the article, but it's quite possible that UHC was _forcing_ him to use the more expensive name-brand drugs due to an agreement that they made with their pharmacy benefits manager (PBM). Some name-brand manufacturers will see generics on the horizon and throw in a clause that obliges the PBM to continue exclusively covering the name-brand drug for X amount of time. UHC specifically fucked me over this way by refusing to cover a widely available generic drug, insisting that they'd only pay for the name-brand stuff, but no pharmacy on earth seems to carry the name brand stuff and couldn't even source it to order it, so UHC effectively denied me the drug altogether. I feel for the guy in the article because the drug that UHC fucked me over about (mesalamine/Lialda) was keeping my Crohn's in check, and after the ensuing flare I had to switch to Remicade, which isn't totally working for me—I'll be switching to something else soon. Obligatory link about PBMs and how they suck: https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing https://www.thebignewsletter.com/p/inside-the-mafia-of-pharm... And being on Remicade myself, albeit at a lower dose (and without Entyvio like he's also taking), I was curious enough to check the EOB for how much my current insurance pays for it. I have Anthem BCBS and here's the breakdown of my last infusion. For context, this is a drug where you have to go to an infusion clinic for administration because it's delivered intravenously. Doctor/facility charges: $21,420.70 Your discounts: -19,563.26 Due to your doctor/facility (max allowed): $1,857.44 Anthem paid: $1,857.44 So the "cost" was 20k for a single infusion, but Anthem negotiated that down to 2k. (I didn't pay anything since I'd met my out-of-pocket limit for the year.) Here's the itemized breakdown of that 20k cost: Drugs Provider charges: 21,020.70 Plan discounts: 19,226.20 Anthem paid: 1794,50 Infusion center Provider charges: 400.00 Plan discounts: 337.06 Anthem paid: 62.94 So the drug cost $1.8k, and they only paid $60 to have someone stick it in me. And for reference, that's name-brand Remicade too, because it's what Anthem's PBM requires. I'm on 7.5mg/kg every 8 weeks, and the highest approved dose is 10mg/kg every 4 weeks. So even if he was on, e.g., 20mg/kg every 4 weeks, that would be maybe $4k worth of drugs once a month, which is $48k a year. Unless Entyvio is way more expensive than I realized, I have no clue how that would add up to a million dollars a year in costs, unless they're sending him to an infusion center that charges crazy high prices (which, if it's part of UHC's Optum network rather than an independent clinic... maybe they do :P)