What are some classic historical examples of 'bad money driving out good'?

There is a drug called dapagliflozin tablets, an SGLT2 inhibitor used to treat diabetes, chronic kidney disease, and cardiovascular diseases. It has broad therapeutic applications and a high safety profile, and is considered a first-line treatment for diabetes and chronic kidney disease—widely recognized and trusted by physicians and patients both domestically and internationally. Its originator is AstraZeneca, and its brand name is Farxiga. In October 2025, during the 11th round of China’s national medical insurance centralized procurement (‘group buying’), Farxiga—which had already exited patent protection—faced intense market competition from multiple domestic and international generic alternatives. As expected, AstraZeneca bid at the original reimbursement price and, unsurprisingly, failed to win a contract. In this round, four Chinese pharmaceutical companies and two Indian firms secured contracts with their generic versions of dapagliflozin—at remarkably low prices. The lowest bid came from the Indian company Hetero, at just ¥0.215 per tablet. Yet this very company—the one that won the contract with the lowest price—received a serious warning from the U.S. Food and Drug Administration (FDA) in September 2025.

After centralized procurement-driven price reductions, are drugs and medical devices really much worse now?

Let me cite a specific example. First, let’s introduce the main subject: the drug dapagliflozin tablets—an SGLT2 inhibitor used to treat diabetes, chronic kidney disease, and cardiovascular diseases. It has broad therapeutic applications and a high safety profile, and is considered a first-line treatment for diabetes and chronic kidney disease—widely recognized and trusted by physicians and patients both domestically and internationally. Its originator is AstraZeneca, and its brand name is Farxiga. In October 2025, during the 11th round of China’s national medical insurance centralized procurement, Farxiga—which had already exited patent protection—faced intense market competition from multiple domestic and international generic alternatives. As expected, AstraZeneca bid at the original reimbursement price and, unsurprisingly, failed to win a contract. In this round, four Chinese pharmaceutical companies and two Indian firms secured contracts with their generic versions of dapagliflozin—at remarkably low prices. The lowest bid came from the Indian company Hetero, at just ¥0.215 per tablet. Yet this very company—the one that won the contract with the lowest price—received a serious warning from the U.S. Food and Drug Administration (FDA) this past September.

FDA Issues Import Alert for Drugs Manufactured at Dabur India Plant

Jun 11, 2026

The U.S. FDA issued an import alert for drugs produced at Dabur India's facility following inspections revealing data integrity lapses and hygiene violations. Dabur asserts domestic operations remain unaffected while implementing corrective measures with regulators.

reuters

2026-06-11

FDA Issues Import Alert for Drugs Manufactured at Dabur India Plant

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FDA Issues Import Alert for Drugs Manufactured at Dabur India Plant

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