>>In the EU there are different prices for pharmaceutical products, usually set to maximize the product of sales and price. This leads to citizens living near borders often shopping for medicine in the cheaper country the same as for gasoline, cars or other stuff where pice difference is marked as well as some market shake up in local pharmacies going head to head with internet pharmacies - with all the local rules to protect the customer thrown in prices in DocMorris and clones are now much higher.

The US experience is that mainly Canadian online pharmacies can offer bargain pricing, causing corporate backlash by the US suppliers who require US citizens to pay top dollar.

IME it's not always the drug these days carrying the cost: often it's the delivery mechanism that is patented. E.g. personal injection devices, some of which are so good that payers are defenseless against customers demanding the product.

IME the only payer that effectively can control pharmaceutical pricing is government in a universal scheme via a mechanism such as Pharmac and even then only if there is a viable competitor or some other lever. Normal insurance companies can protest, but the only control to be exerted is to threaten to de-list coverage. Another best other way is by being a poor nation that simply cannot afford extortionate prices or that has access to "good enough" lesser remedies at much better price.

>>Sometimes insurance companies fight back by asking doctors to specify specific reasons for prescribing higher priced ones...

Often it's just habit to prescribe a name brand rather than a generic... but again, legislation can allow substitution with generic unless a specific protocol is followed in which case the physician should be ready to justify their stance.

At this rate it won't matter for long: few US pharmaceutical companies have good patents in the pipeline, so there's going to be a lot of generic competition out there.