>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.

Yes, and that will be a good thing.
As I've said many times, someone has to tell me why all these leggy women who sell pharma products are hanging around MD offices whenever I go in. (Please don't chase them away, I love to watch them walk)
Big phama isn't stupid. They're getting some ROI on those legs.

That said, there's still a lot of inefficiency in the system,
I've been fighting persistent coughing and sniffles so this week the MD prescribed an anti-allergant.
Using the latest tech, instead of writing the scrip, he sent it digitally to my pharmacy - CVS.
CVS called me an hour later and said that the MD had ordered a drug not covered by my plan - Medicare D.
So they called the MD and he prescribed another (all that took 24 hrs.)
Guess what, that wasn't covered either.
Finally, I paid cash to break the loop and get my meds. They worked and I'm doing much better.

So, the people in the loop are doing a lot of unnecessary work and they and the consumers are enduring stress that adds no value.
If the MD could have seen my plan, he could have ordered one that was there, or if there were none, told me that I'd have to pay for it.
I could have decided that in his office.