Strict drug formularies to control costs
The high cost of drugs means more insurance and government programs will rely on strict drug formularies to control costs.
This introduces competition and requires that manufacturers keep their costs down in order to get their drug listed on the formulary.
But sometimes formularies go too far. Formularies that are too "tight" actually increase costs...patients go back to the doctor more often...need more lab tests...don't take drugs that have more side effects, etc.