Yes, Upjohn’s patent on Cortef has expired, but since it makes so little profit, no other company has bothered to make a generic.

I would find it hard to believe that HMO’s would place patient need above profitability when it comes to the benefit packages it offers companies. They don’t exist to help people, they exist to make money. Some like making it in a moral and honorable way, some couldn’t care less. Either way if employers want to cut personnel expense, the HMO will have to provide cost saving plans or the employer will simply go to a different HMO. That’s how the real world works.

Ultimately it comes down to who pays what share of the cost of the medicine. Each player has choices. The employee can go find a job that offers better benefits or stay where they are. The HMO can offer to pay more or less of the cost. And the employee can decide how much he wants to spend to keep qualified employees. the economy influences the decisions, quite a bit.