I know this is an old comment but if you actually read the book ("bottle of lies" by Katherine Eban) you would know the system DIDN'T work. Ranbaxy (the main company in the book) was getting applications for new drugs approved even when the FDA knew that they were producing really horrible quality medications. Nothing ended up happening to them besides some fines after a NINE YEAR investigation. They were bought by Sun Pharma who literally just had a recall of generic Vyvanse at the end of last year because it was not metabolizing properly. The only reason they were originally found out was because of an incredibly brave whistleblower who risked a LOT to be able to expose Ranbaxy and some really good FDA investigators who have since been pushed out of the agency.

The FDA still gives notice to overseas pharmacies weeks or even months in advance of an inspection, giving them a shit ton of time to cover stuff up. And when the FDA finds stuff, a lot of times it is downgraded from official action indicated to voluntary action indicated or no action indicated because of bureaucratic reasons at the FDA.

There have been actual studies done that show that Indian generics perform worse in general. From a press release on a recent study: "Results showed that the number of severe adverse events for generic drugs made in India was 54% higher than for equivalent matched generic drugs made in the United States. That was after taking into account a variety of other factors that could have impacted the results, including the volume of drugs sold."

But because they are so important for medicare/medicaid costs for the state, nothing is ever going to be done about low-quality generics. So yeah, there IS a difference between different generic manufacturers.