When a drug’s patent runs out, prices don’t just dip-they collapse. It’s not a slow fade. It’s a crash. And it’s not just a theory. It’s happening right now, with real people paying $10 instead of $850 for the same pill. The moment a brand-name drug loses patent protection, the market flips from a monopoly to a free-for-all. And that’s when the real savings begin.
What Happens the Day After Patent Expires?
The first generic version hits shelves within months, often priced 20% to 30% lower than the brand. That’s the baseline. But here’s the catch: the real price drop doesn’t come from the first generic. It comes from the third, fifth, or tenth. Each new manufacturer brings more competition. More competition means more pressure to cut prices. By the time five or six generics are on the market, the drug can be selling for less than 10% of its original cost. Take Eliquis (apixaban), a blood thinner. Before its patent expired in 2020, patients paid around $850 a month. Within a year, generic versions hit the market. By 2023, the same dose cost $10 a month. That’s not a typo. That’s 98% off. And it’s not rare. According to a 2023 study in JAMA Health Forum, U.S. drug prices fell 82% over eight years after patent expiry. The first generic cut prices by 15-20%. The tenth? It drove them down 80-90%.Why Do Prices Drop So Fast?
It’s simple economics: supply meets demand. When only one company makes a drug, they set the price. No competition. No pressure. But as soon as others can legally copy it, they do. And they don’t need to spend millions on research. They just need to prove their version works the same way. That’s called bioequivalence. It’s cheaper, faster, and the FDA approves it in about 10 months for simple pills. Manufacturers of generics don’t need fancy marketing teams. They don’t need to pay for TV ads or celebrity endorsements. Their only goal is to sell as much as possible at the lowest price. So they undercut each other. And the customer wins. But it’s not just about pills. Complex drugs like biologics-injectables used for arthritis, cancer, and autoimmune diseases-take longer. These aren’t simple chemicals. They’re made from living cells. Copying them is harder. That’s why biosimilars (the generic version of biologics) take years to enter the market. Humira, a top-selling arthritis drug, had its first biosimilar approved in 2023-seven years after its main patent expired. Why? Because AbbVie filed over 130 secondary patents to delay competition. That’s called a patent thicket. And it’s common.Patent Thickets: The Hidden Delay
Most people think patent expiration means instant competition. It doesn’t. Drug companies have mastered a tactic called “evergreening.” They take an existing drug, make a tiny change-a new dosage form, a slightly different chemical tweak, a new delivery method-and file a new patent. This isn’t innovation. It’s legal maneuvering. According to the R Street Institute, 78% of new patents filed between 2010 and 2023 weren’t for new drugs. They were for old ones. And 70% of the top 100 prescribed drugs had their exclusivity extended at least once. The average blockbuster drug now gets 10 to 15 secondary patents. Together, they add 12 to 14 extra years of monopoly pricing. Semaglutide (Ozempic, Wegovy) is a current example. The base compound patent expires in 2026. But the manufacturer has filed 142 patents across three formulations. Experts say this could delay generic entry until 2036. That’s a decade of inflated prices, even after the original patent is gone.
Why Do Prices Vary So Much by Country?
The U.S. isn’t the only country dealing with this. But it’s the worst. After eight years, U.S. drug prices fell 82%. In the UK, they fell 60%. In Australia, 64%. In Switzerland? Just 18%. Why? Because other countries control prices. Germany, France, and Canada use reference pricing-they look at what other countries pay and set their own prices accordingly. They negotiate directly with drugmakers. The U.S. doesn’t. Medicare can’t negotiate prices for most drugs. Insurance companies do, but they often prioritize rebates over list price. That means even when generics are available, patients might not see the savings if their plan doesn’t put the cheaper version on its preferred list. A 2023 Kaiser Family Foundation survey found that 68% of insured adults saved money when generics came out. But 22% said their insurance made them wait-sometimes for months-before covering the cheaper version. That’s because rebates between drugmakers and insurers can make the expensive brand more profitable for the plan than the generic.Who Benefits the Most?
Patients. Healthcare systems. Taxpayers. Everyone except the original drugmaker. In 2023, the U.S. spent $400 billion on prescription drugs. The Congressional Budget Office estimates that generic and biosimilar competition will save $1.7 trillion over the next decade. That’s money that can go to hospitals, doctors, or lower premiums. But it’s not automatic. If patent thickets aren’t cracked, those savings get delayed-on average, by 4.2 years per drug. Generic manufacturers are thriving. The global market was worth $407.5 billion in 2023 and is projected to hit $700 billion by 2030. Companies like Teva, Mylan, and Sandoz are investing billions to build factories, hire chemists, and file applications. They’re betting on patent cliffs. And they’re winning.
