At the same time, few people in poor countries have been able to get lower-priced generic antiretroviral drugs.

Until that happens, to ensure safety, a good intermediate step is for states and cities to step in and provide access to lower-priced drugs.

States across the country have been trying to figure out ways to allow their citizens access to lower-priced Canadian drugs.

Governments, for their part, are very willing to buy the lower-priced drugs.

We want to see lower-priced drugs on the market as soon as possible, not delayed by lucrative payoffs.

Drug sales are growing 8 percent a year in units, including lower-priced generic drugs without patent protection.

As a result, spending on lower-priced generic drugs may account for 50 percent of the companies' total expenditures, Mr. Jacobs said.

Dozens more are requiring Medicaid recipients to use generic or lower-priced drugs from preferred lists.

The lure of the 180-day window was the generic drug industry's incentive to bring patent challenges and hence get lower-priced drugs to the market sooner.

In addition, a growing number of insurers, health maintenance organizations and other cost-containment plans are strengthening incentives for patients to use lower-priced, alternative drugs.