Not sure if your comment is specific to the US, but my gf is a doctor working in public healthcare here. She has worked with private healthcare and doesn't enjoy it as she says half of the time is battling with insurance companies trying to get them to pay for the best drugs for the patient, while insurance companies always want to pay for the cheapest drug for the patients.
In a not life threatening situation, wouldn’t it make sense to try out the cheaper drug first? When you are paying the bills, that is what you do. Roof springs a leak? Try a $20 patch first. Don’t immediately spend $8,000 tearing off and installing a new roof. But when you are spending other people’s money, it’s real easy to try and skip steps.
If insurance didn’t push back, costs would be even more bonkers!!
She specialised in a long term degenerative illness, so giving an inferior drug may lead to a big loss of life quality down the road, an increase long term costs of treatment and care.
