The insurers here often force people to take the more expensive, brand-name things and refuse to cover cheaper alternatives.
Really? I've never had an insurance that didn't push hard for the generic if there is a generic version of the same drug. Actually, to go a step farther, by state law all pharmacists here are required to substitute the generic unless either the doctor specifically notes brand name only on the prescription or the patient demands it.
But sometimes there isn't a generic, and sometimes it's more complicated than that.
For example, I went on Lantus within 6 months of it hitting the market, and it was like night and day as far as my blood sugar goes. I was on Lantus until Basaglar and then Toujeo hit the market, at which point my insurance decided they were equivalent enough (they're all functionally similar very long acting insulins, but aren't biosimilar because that is shockingly difficult to achieve for this kind of drug) to only include one of the three in the formulary and only cover the others at all with special pre-approval.
None of these are a generic, because no biosimilar generic exists and it's very unlikely any biosimilar generic will exist in the foreseeable future. For most intents and purposes Basaglar is functionally generic Lantus and Toujeo is functionally concentrated generic Lantus, but not *exactly*, not closely enough for pharmacists to be required to substitute (because it is possible to have different reactions to them because of differences in the production pathway despite being essentially the same drug). By "concentrated", I mean that Toujeo is only distributed as U-300 while Lantus and Basaglar are only distributed as U-100, these U- numbers being a measure of units of insulin per mL. It being more concentrated can influence absorbtion, but also reduces the total fluid volume being injected (which honestly makes for more comfortable injections as dose increases).