JAMA Network Open highlights the lack of price competition in brand-name cardiovascular drugs that significantly impacts patient care. It confirms what I've noticed and been infuriated by when prescribing direct oral anticoagulants (DOACs) in clinical practice over the last 10 years. When the first DOAC -- Boehringer Ingelheim's dabigatran (Pradaxa) -- was approved a decade ago, this oral direct thrombin inhibitor became the first new oral anticoagulant approved in the U.S. in more than 50 years. The RE-LY trial showed that 150 mg twice daily lowered the risk of stroke and systemic embolism by 35% beyond the reduction achieved with warfarin, which had been the standard of care for patients with non-valvular atrial fibrillation (afib).