The cost of medication-assisted treatment (MAT) for drug addiction may be going down as two generic versions of the popular Suboxone sublingual film were approved for sale in February. That’s not guaranteed in the long run.

Generic drugs are drugs whose patent has expired so no one drug company has the exclusive right to produce it and sell it. The way this is supposed to work is that more than one generic drug maker will produce a version of the drug, with competition reducing the price considerably.

It doesn’t always work out that way. If only one or two companies produce the drug, the price may remain about as high because there is not enough competition.

According to Stacie Dusetzina – an associate professor at Vanderbilt University Medical Center whose area of study includes drug pricing – “the magic number seems to be around four manufacturers.”

Another problem is when competitors raise prices about the same amount at about the same time, a not uncommon occurrence.

There are at least three possible reasons:

  1. A rise in the real costs of producing the product or service.
  2. Coincidence.
  3. Price-fixing.

Forty-four states have filed a lawsuit against 20 generic drug makers, accusing them of the third possibility in a lawsuit, including Teva Pharmaceuticals and Pfizer subsidiary Greenstone. Both deny they have done anything warranting such a lawsuit.

The lawsuit alleges the generic drug makers knew that what they were doing was illegal and so “avoided written records by coordinating instead at industry meals, parties, golf outings, and other networking events.”

But there are other ways pharmaceutical companies can keep prices high or even maintain an exclusive patent a little while longer. One of them is evergreening or product hopping: changing the formula just enough that it qualifies for a new patent.

That’s how Suboxone came about. It contained the mild opioid buprenorphine, often used in MAT for people recovering from opioid use disorder (OUD), plus the opioid antagonist naloxone to prevent the high if the Suboxone is misused (crushed or dissolved for snorting or injection). The patent on buprenorphine was expiring at the time, so the tweak preserved the monopoly.

When the patent protection on Suboxone was expiring in the US, the manufacturer introduced Suboxone sublingual film and argued that the tablets should no longer be permitted because they were dangerous. (It still sells them overseas where they are still under patent. Coincidence?)

More recently the manufacturer has tried to prevent the release of Suboxone film generics, but they are now available.

Don’t worry about the Suboxone manufacturer’s profits: It has already released a once-monthly injection version, Sublocade, and is seeking patent protection blocking a rival’s similar product for seven years.

There seems little doubt that Big Pharma games the system, but it’s disturbing to note that generic manufacturers have likewise been gaming the system, or that in some cases (such as Pfizer and Greenstone), Big Pharma and generics are one and the same.

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