Competition in generic drug markets

There is even less competition then we may have thought according to a paper out this month by Socal et al. (2023):

We identified a total of 565 facilities producing 1,379 unique generic APIs across forty-two countries. India, China, and Italy were the top producers; 14 percent of APIs were manufactured in the US. About a third of APIs were manufactured by a single facility, and another third were manufactured by two or three facilities. More than one in every five APIs reflected markets in which current Food and Drug Administration standards would have failed to detect low competition because there were three or fewer API manufacturers despite there being four or more manufacturers of finished generic drugs

In short, even if you have a lot of finished generic drug makers, if there are only a few facilities that make the active pharmaceutical ingredients (APIs), that is highly problematic. 60 Minutes reported on this issue a few months back.