They Picked Your Medicine. You Just Pay.
- 11 minutes ago
- 2 min read
I have good news and bad news, and they are the same news.
The good news: some of the most outrageously priced brand-name drugs in America are finally going generic, and that means we can get them cheap. Four big ones have flipped just this stretch. Nobody talks about it, so I will.
Farxiga was the most exciting so far. It did not slowly drift down the way drugs usually do. The day it went generic, it got cheap instantly. There was one snag: a lot of insurance plans would not cover the cheap version. We have sold a ton of it anyway, so plenty of people quietly saved real money.
Now today's drug: Humira. This one cost Medicare about $4.5 billion in 2024 alone. One drug. Then it finally got biosimilar competition, a whole shelf of them. And the market moved with the snap of a finger. Biosimilars went from 0.3% of the market in 2023, to 21% in 2024, to 82.4% in 2025.
Here is where the good news becomes the bad news. When I say it moved with the snap of a finger, I mean somebody snapped it. The insurance companies and their PBMs sat down and decided which biosimilars they would cover. And guess which ones they picked. Not the best clinical option. Not the cheapest, and there are versions out there with 95% discounts. They picked their own white-label products. Express Scripts, CVS Caremark, and OptumRx excluded nearly all the non-house-brand biosimilars from their 2025 formularies.
Think about what that means. They took one of the biggest drug markets in the world, and instead of letting the cheapest option win, they routed the money into products they own. In a normal competitive market, the low-cost product earns its place. That is not what happened here.
And here is the part that should really get you. The patient did not choose. The doctor did not choose. The people with the actual medical knowledge, and the people it actually matters to, did not get a vote. But the patient is the one paying for it. It is not the insurance company's money they are moving around. It is yours. They quietly took over a market that you fund, then turned around and told you which medication you are allowed to take.
That is the whole game in one story. That is why we fired them. No formulary tricks, no house-brand markup, no hidden middleman deciding your prescription for you. You see the real price and you decide.
Sources: Drug Channels; PSG/Artemetrx 2026 Specialty Spend and Trend Report; Medicare Part D spending data.
