What I find interesting is that there isn't any mention as to whether or not less expensive (or more expensive, for that matter) alternatives exist and are being used.

That's one of the fun things about all the new drugs. Many are more effective than what they're replacing, but not all are. Some may get the same results but have less side effects - but what one really needs to look at is the overall cost of treatment. If it's cheaper to prescribe an older med, and even some ancillary meds for side effects, than it is to prescribe the new wonder drug and one gets the same results, why approve and pay for the more expensive version?

Ron, the problem is that a new treament might be just as good and less expensive. But we'll never know, because the FDA has insanely stringent requirements for "noninferiority" trials, and therefore the price of a noninferior equivalent is artificially inflated.

See, that's the funny thing about the FDA--if you do a study trying to prove superiority, then if you don't prove superiority then your drug doesn't get approved. Even if the evidence shows noninferiority. If you want to do a noninferiority study, then you have to throw out all the previous data and start over again.

I don't say that the process isn't inefficient as hell. Not at all, but I do note that there are many different treatment pathways were a current grouping of generic drugs as well as other therapies that can be cheaper in total than the new wonderdrug.