bblack Doesn’t really work like that. Say Amarin spends $30/bottle to produce. Sells it at $250 to wholesalers who sell to pharmacies for $300 who mark it up to $330 for cash paying pts. Amarin reimburses insurance co (or PBP) $90 so their actual profit is $160. Cash paying get $90 coupon so Amarin still makes $160. If insurance deductible is high then Amarin coupon brings it down to $9 for the Pt and Amarin’s profits are a little lower. Generics come along. Their cost is maybe $50. They sell for $60. Low margin but big sales on virtually no operating costs. They sell 100 drugs, no really extra operating costs to sell 101. If Amarin wants to compete they have to lower price to $60. Higher margin than generics but they have to pay for the operation of the company. Pt comes in and has an Rx for V. $60 for gV or “x” for V. Insurance will almost always only pay for least expensive or charge the Pt for the difference between least expensive and what the Pt chooses. On an open market (without legal barriers to R-it population) Amarin doesn’t stand a chance. (Just pulled these numbers out of the air as an example) Disclaimer: individual arrangements with insurance/PBM’s is not something I know a lot about - I don’t live/work in US so I don’t have any experience with that business model.
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