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Patients suffering from painful, sometimes life-threatening diseases often find the struggles hardly end when the treatments are over. Co-payments and other out-of-pocket costs for drugs, on top of the bills for the uncovered portion of doctor and hospital visits, can linger for months or years, especially for chronic conditions such as heart disease and cancer. Pat Mastors started the Patient Voice Institute after her then year-old daughter came down with Guillain-Barre syndrome in Struggles over the cost of drugs lead many into debt, bankruptcy or even ill-advised strategies such as splitting pills or skipping days to make medications last longer.

This article was written through collaboration between The New York Times and ProPublica, the plavix drug prices, nonprofit investigative journalism organization. Fein, president of Pembroke Consulting, who researches the drug-distribution industry. The spike in prices of doxycycline and other generic drugs led to a congressional investigation as well as state and federal inquiries into price-fixing that are still underway. A coalition of state attorneys general have accused a number of companies of colluding to keep prices high.

The magnitude of this wave of expiring drugs patents is unprecedented. Top drugs getting generic competition by September are taken by millions every day: Lipitor alone is taken by about 4. The new generics will slice copayments of those with insurance. For the uninsured, who have been paying full price, the savings will be much bigger.

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