The brilliant brand name drug marketers, per this New York Times article,  have found a simple way to undermine the consumer incentives in place to encourage use of generics: cover the co-pay differentials that patients would otherwise need to pay, and sock the big difference in cost to the carrier and therefore to the employer or ratepayers and ultimately others in the plan.

This is one more example of the inherent flaws in a health care system where the consumer is not paying in any direct way for the choices that they or their doctors are making. If the cost of a particular drug were somehow felt by the patient, and there were two choices—one expensive and one less so—the consumer would make some of their own cost benefit decisions and in many cases, select the less costly alternative.

The problem outlined by these practices can and should be dealt with either legislatively—by prohibiting incentives to patients designed to undermine plan designs— or by the plans themselves, deciding to not cover such drugs absent an effective appeals process.