The U.S. President—“Nobody knew health care could be so complicated.” *Sigh*. Sometimes it is so complicated that it is hard to even follow the money. A recent New York Times article sheds some light on how messy things can be. The premise is that some pharmacy benefit managers and insurance companies are directing patients to take brand name products when there are approved generic options. Whatchu talkin’ bout Willis? With more biosimilars coming to market to “replace” high priced biologic medications, it’s likely that patients and advocacy groups will get vocal. If you look at the top drugs in terms of volume, the word “generic” appears in most of them and you have to get down to #39 before you see Cialis. We will leave it there for another Insight City article.