With regard to the Ketamine example, what the drug company is selling is a nasal spray (versus the traditional method of using an IV), and freedom from the stigma of taking a "party drug": https://www.theverge.com/2019/3/11/18260297/esketamine-fda-a....
There was a similar example with anticoagulants where the generic (warfarin) required monthly blood tests, so the drug company developed a version that doesn't require the monthly blood tests, and charges $5k/yr more for it. Is it good public policy to spend $5k/yr per patient to avoid a monthly blood test? We don't have that conversation in the US, and it costs us.
Note that patient doesn't see the $5k/yr increase. They just pay the $35/mo co-pay instead of the $15/mo co-pay. However, the rest of us do pay that cost. Again and again and again.
We already had inhalable insulin in 2006 (Exubera) and again in 2014 (Afrezza), both of these medications were withdrawn from the market for lack of sales. And yet people still get upset when Pharma spends money on marketing...
The "so what" is that the current system prevents people from getting affordable access to drugs.
This may not matter to you, and that is certainly well within your rights, but many people do seem to care about ensuring other humans aren't priced out of medicines that may help.
Ketamine as a generic work and is available in lozenges, IV, and other ways. This nasal spray is being marketed as a breakthrough for depression (even though it isn't), costs more, and because there are no marketing dollars behind the other equally effective method, people will likely end up using this branded version.
>There are lots of marketing plays on existing, well-established technology. That's like half the things Silicon Valley develops. So what?
The "what" is that here, peoples' health is at stake, and simply taking a market-driven approach may not be to the benefit of society.