lowers the prices is ok by me.

As long as it doesn't impact on patients being able to get what they really need.

And as much as americans aren't going to like it, there is going to have to be some rationing here. These ultra-expensive drugs have their place, but it may be that not everyone should be able to get them.

only difference is the name on the label. It shouldn't happen otherwise unless the less expensive medication actually does what is needed.

Ex. 1: If I stay on name brand Synthroid, my dosage is rock solid. If I switch to the generic, my dosage goes up and down repeatedly.

Ex. 2: I went to school with someone who is now a doctor - a rather influential one. I about fell over when she commented instead of prescribing a new, very effective drug, she thought the old, less effective drug with more side effects was good enough for her patients on Medicare. (Sorry that I can't recall the specific drugs she named.)

Ex.3: there are many conditions (Depression, high blood pressure) for which there are different drugs and even different types of drugs.
Very often, it's the expensive drug that works the best and has fewer side effects for some patients.

FWIW - I am on a number of scripts for my autoimmune disease, and only one of them is still the name brand. I loved going from a monthly co-pay above $175 to about $25 as my medications went to generic!

I think patients come first, but I also think it's important to realize that some compromises may in order.

Ex 1: Small variations in thryoid functions are not really a big deal unless you become significantly symptomatic. If your dose is being altered based on blood tests alone when on generics, it may be completely unnecessary. But sometimes it does make sense to stick with the brand name product.

Ex. 2: Pharmaceutical costs associated with Medicare are astronomical. Brand new drugs are particularly costly as there is no generic equivalent. They are sometimes also higher risk because they haven't been in the general population that long. A decision to continue to use what is known, even though it appears to have more side effects, is sometimes a very wise choice.

Ex. 3: When there are multiple drugs available for a certain condition, physicians and patients should have the option of having repeated trials until they find what works. But, frankly, they should start with the least expensive alternatives first, all other things being equal.

as far as #2 goes, I wish I could name the two drugs. You'd recognize them and realize that this doctor was really giving her poorer patients sub-par care. It's one thing to try to reduce medical costs, but she was rationing based on whether the government or the insurance company was buying the drugs! She said something on the order that X was good enough 30 years ago, it's good enough for those people now.

Medicaid is the program for the poor. So I'm not sure you can conclude that she was giving her poorer patients sub-par care. Medicare patients have to sign up for part D plans that cover medications. They may have restrictive pharmacies. The issue, in those cases, is whether the companies covering the meds have made a decision not to cover certain drugs, and it may be out of the hands of the physician.