The Real Story of A Generic Drug

We are continually being told that we can save money if we switch to generic drugs, as if this is a great new idea. I don't know of anyone who doesn't use generic prescription drugs. If they exist, that is.

This is the story of a drug manufacturer, its favorite cash cow, and what happened when the patent ran out.

Cephalon, Inc makes Provigil. It's used for nacolepsy and fatigue. Cephalon has made a lot of money with it, but the patent was due to expire in 2005. Various generic manufacturers filed applications with the FDA to manufacture and market the drug in 2002. In 2003, Cephalon filed patent infringement lawsuits against each of the generic companies. This gave the generic companies a long and expensive fight for the right to manufacture a generic version of Provigil.

Cephalon had a better solution for them. Cephalon paid them to not market any generic drugs until 2011 or 2012. Case settled. And they make lots of money to do nothing.
http://www.prescriptionaccess.org/lawsuitssettlements/current_lawsuits?id=0024


This was a little expensive for Cephalon, but they had a solution for that too. First they jacked the price of Provigil way up. Then they made a few minor tweaks to Provigil, and changed the name to Nuvigil. This gave them a brand new patent that will last till 2023.

http://blogs.wsj.com/health/2008/11/18/eyeing-generics-cephalon-hikes-price-on-provigil/

http://stanford.wellsphere.com/healthcare-industry-policy-article/why-did-cephalon-close-its-provigil-patient-assistance-program/419859


Cephalon also plans to have a larger customer base for Nuvigil. They are marketing it for Eastbound jet lag. Some very lucky drug study subjects got an all expenses paid vacation to France in order to show its effectiveness.
http://industry.bnet.com/pharma/10002938/cephalons-nuvigil-test-included-vacation-in-france/

This created a lot of fun and games for the drug manufacturers, but what about the poor health insurance companies that have to pay for it? No problems there either.

I have chronic fatigue. I've been taking Provigil for a couple of years. A few months ago, when I went to pick up a refill, the lady at the pharmacy gave me a chipper "That'll be $379.43." Blue Cross changed the rules and didn't bother to tell me, or my doctor. A sleep study is now required before they can approve Provigil.

That's nice, but what am I supposed to do in the mean time. Not even the greatest health care system in the world can get you a sleep study & diagnosis in a day.

My doctor tried to get me an extension, but Blue Cross wasn't interested in any little problems their rule change might have created.

Next I got my exployer's HR department to talk to Blue Cross. That worked. I got an extension. It's no longer "preferred", and will cost me $50, but that's better than $400. Unfortunately, Blue Cross departments don't talk to each other. I've been round and round with my doctor and the pharmacy. They can't convince Blue Cross, that Blue Cross has given me an extension.

So, I'm stuck without a medicine that I need. I'm always sleepy, and have trouble getting anything done during the day. And I have to deal with this mess.

What's really great about this ordeal that Blue Cross put me through, is that it never would have happened if I was on Medicare. The Blue Cross formulary for Medicare lists Provigil as "preferred". No sleep study required.

Why can't I buy into Medicare, if I want to?

Update: I've had the sleep study. The sleep doctor gave me a new prescription with special approval. Blue Cross can't find the approval.