I believe that much may depend on who's treating you, and how much they fight for what they want. As a patient at City of Hope, I don't know of any test, scan, drug, etc that was denied after COH worked with whoever was necessary to get it authorized. On a few occasions it took a couple days for an authorization, but I got what the Doctor wanted.
My internist is offering concierge services, if you pay for it, he'll include fighting the drug company, and other things for what he'd like for the patient at no added charge. If you don't go for it, if he prescribes a drug, and the insurance turns it down, he'll fight for it at an additional fee, or he'll prescribe something else that they may go along with without a fight. I was recently prescribed something new, but he indicated a genetic was acceptable, and as fate had it, a generic just became available, no fight. The druggist questioned whether the prescription would be authorized until she found the generic, then it was no problem.
I mention this because I think it illustrates what's wrong. To begin with, the company originally supplying the drugs could price them lower if they knew they'd maintain patent rights longer. Secondly after all costs and a reasonable profit was achieved they would lower prices somewhat for even longer patent protection. In short, if prices came down sufficiently, many drugs wouldn't be challenged by generics which in the long term would benefit the original developer. Overall cost would go down, but companies would be as or more profitable than ever before.
Gary
