By NextBestFitPublic manufacturing of off-patent drugs
A public or nonprofit manufacturer produces generics with high prices or shortages (e.g., insulin).
Public or nonprofit production of off-patent drugs with high prices or shortages.
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This path
Public manufacturing of off-patent drugs
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Fund a public or nonprofit manufacturer for off-patent drugs with high prices or shortages
- Guarantee volume purchases
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Brand-name drug prices far above production cost
Public or nonprofit manufacturing directly lowers prices for targeted off-patent drugs such as insulin.
- Drug shortages of cheap, essential generics
Public or nonprofit production of drugs affected by shortages improves supply resilience.
What it creates or worsens
- Solves only part of the problem
Public or nonprofit manufacturing covers only off-patent drugs.
- Takes years, or money up front, before it pays off
Establishing public drug manufacturing can be slow and costly.
Who's affected
Who gains
- People with unaffordable deductibles or coinsurance
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Uninsured people
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Health insurers, brokers, and their shareholders
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Taxpayers and public budgets
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- People with ongoing or specialist care needs
- Drug shortages of cheap, essential generics: Essential generic shortages interrupt access to chemotherapy and emergency drugs.
- People needing emergency or trauma care
- Drug shortages of cheap, essential generics: Essential generic shortages interrupt access to chemotherapy and emergency drugs.
- Hospitals, clinics, and care organizations
- Drug shortages of cheap, essential generics: Dependence on few factories leaves hospitals exposed to essential drug shortages.
Who loses
- Drug and device makers
- Brand-name drug prices far above production cost: Market exclusivity supports high prices and shareholder returns.
- Pharmacy benefit managers and their pharmacies
- Brand-name drug prices far above production cost: High list prices generate rebates for benefit managers.
Where it has been tried
- California CalRx; Civica Rx: State-branded insulin and nonprofit generics.
- California: In October 2025, California announced CalRx insulin glargine would launch in January 2026 at a suggested retail price of no more than $55 for five pens.Sources: Governor of California (2025)