Welcome to Sisyphus Highway: In Depth.

In October 2025, direct passenger flights between China and India resumed after five years. India is known as the “pharmacy of the world.” Before COVID-19, Indian generic drugs became a major topic in Chinese news, and many people even traveled there for treatment.

Meanwhile, China’s centralized drug procurement has prompted continued public debate. At the end of 2024, the tenth national procurement round set another price-cut record: more than fifty products fell over 90 percent, some pills cost only a few fen, and not one originator drug won a bid—the first such result since the system began.

These stories bring us to a subject closely connected with everyone’s life and health: generic drugs.

We begin with the basics and introduce recurring terms such as FDA, reference listed drug, patent cliff, and GMP. We hope to build a framework for understanding generics and narrow some everyday information gaps about medicine.

 

- Why discuss generics?

- What exactly distinguishes generic and originator drugs?

- Generic and brand names: why is acetaminophen also called Tylenol?

- Why might the second pill cost only one dollar while the first costs billions?

- What is generic-drug consistency evaluation? Does “equivalent” mean identical?

- With the same active ingredient, why can release rate affect efficacy?

- What are the FDA, ANDA, reference listed drugs, the patent cliff, and GMP?

- Why does Hyderabad contain so many Indian generic manufacturers?

 

- FDA (term): the U.S. Food and Drug Administration ensures the safety, efficacy, and controlled quality of food, drugs, biologics, medical devices, and other products made in or imported into the United States. A company seeking to manufacture a generic drug submits an Abbreviated New Drug Application (ANDA) to the FDA.

- Reference listed drug (term): the reference product used in an application to register a generic drug.