Resumo
Insurance schemes play a key role for drug access by populations in need. The interplay between public and private insurance is one of the main dimensions of the delicate design for drug coverage. Canada and Brazil have a distinct approach, briefly presented on the basis on the OECD typology for health insurance. The pharmaceutical industry is currently facing a ‘patent cliff’ where many ‘blockbuster’ drugs come to the end of their patented life. The industry is setting up new ‘loyalty programs’ enticing patients and health professionals to stick to the brand name drug instead of switching to the generic. With the bioequivalence of generic drug, there is no additional health benefit to stick to brand name drugs when generics are available at a fraction of the price. The best part of the additional costs of such commercial programs is not paid by the pharmaceutical industry. Instead, programs are based on the possibility to transfer the increased cost to the insurer.