- Jack Ringel
- Oct 5
- 4 min read
What if Superman was not able to afford the antidote to Kryptonite? What if Achilles could not pay for the surgery to repair his own heel? What if a vampire didn’t have enough money to buy a cloak to shade him from the sun?
For these fictional characters, finances are never the enemy, their struggles are always against their foes. But in the real world, people depend on life saving medication and devices that are not always affordable. For someone with a severe allergy, that tool is an EpiPen. For someone with diabetes, it is insulin. These are not luxuries or enhancements, they are lifelines. Yet, access to them is often shaped by patents, pricing, and policy that can put them out of reach.
When someone with a severe allergy is exposed to an allergen, they can undergo a severe immune response called anaphylaxis. Symptoms include hives, low blood pressure, and even swelling of the throat that can make breathing impossible. Epinephrine, the active drug in EpiPens and other auto injectors, works to counteract these symptoms by opening airways, reducing swelling, and raising blood pressure [1]. The drug itself is inexpensive and costs about $5 per milligram, and in a standard autoinjector there is 0.3 milligrams of epinephrine [2]. According to Food Allergy Research and Education (FARE), manufacturing an EpiPen two-pack costs about $8. [3]. Yet, depending on one’s pharmacy and insurance coverage, patients often pay between $320 and $750 for the same product.
For people with diabetes, insulin is just as essential. Without it, severe complications such as diabetic ketoacidosis and organ failure can occur. Insulin works by allowing glucose to enter cells, lowering blood sugar levels and preventing these dangerous outcomes [4]. The drug itself is cheap, as a vial of insulin can be manufactured for about $5 to $10 [5]. However, the retail price in the United States is far higher. A vial of insulin can cost as much as $300 without insurance [6]. While recent reforms like the Inflation Reduction Act have capped insulin costs for Medicare patients at $35 per month, many still face unmanageable prices [7].
EpiPens and insulin are just a few examples of high priced medicines that are cheap to produce. This difference between the low cost of production and the high price at retail raises ethical questions. If these medications are necessary for survival, why should pharmaceutical companies be permitted to price them like other free market goods?
Possible answers lie in patents, funding research, middlemen, and insurance companies. In the United States, pharmaceutical companies are granted patents that give them years of exclusive market prices without competition from generics. Companies often justify high costs by pointing to investment in research and development. Studies have shown, however, that research spending often is not correlated with the market price of a drug [8].
Instead, Els Toreele argues that drug companies charge so much due to patent monopolies [9]. These monopolies use systems like “evergreening,” where small modifications to existing drugs prolong exclusivity periods [10]. This can delay the creation of cheaper generic alternatives from other companies.
Beyond patents, the price of medicines is also affected by pharmacy benefit managers (PBMs), insurance companies, and rebates. PBMs are middlemen that negotiate with drug manufacturers for insurance companies. In these negotiations, manufacturers often agree to pay rebates (a discount) for favorable placement for their drugs. Ideally, this system would lower the price of drugs. According to Harvard Health, however, these rebates usually do not reduce what patients pay [8]. Instead, manufacturers may raise the price of the drug to make up for the cost of the rebate, raising the consumer price.
Pharmaceutical companies continue to argue that high prices are needed to fund innovation, while critics point out the vast disparity between production costs and retail prices. The challenge lies in finding a balance between supporting innovation and ensuring access. Recent reforms in the United States, such as capping insulin costs for Medicare patients, show efforts to address the problem. But prices remain much higher in the United States than in countries where governments play a stronger role in negotiations and price caps. The central question remains: How can society reward innovation while keeping life-saving medication in reach for those who need it the most?
Reviewed By: Alec Vazquez-Kanhere
Designed By: Ariha Mehta
References:
Allergy & Asthma Network. (n.d.). What is epinephrine? https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/.
Harvard Health Publishing. (2016, October 12). A way to lower the cost of EpiPens. Harvard Medical School. https://www.health.harvard.edu/blog/way-lower-cost-epipens-2016101210460.
Food Allergy Research & Education. (2023, July 20). FARE endorses Rep. Maxwell Alejandro Frost’s EpiPen Act. https://www.foodallergy.org/media-room/fare-endorses-rep-maxwell-alejandro-frosts-d-fl-10-epipen-act.
Cleveland Clinic. (2022, August 11). Insulin: What it is, function & types. Cleveland Clinic. https://my.clevelandclinic.org/health/body/22601-insulin.
Yale School of Medicine. (2019, April 3). The price of insulin: A Q&A with Kasia Lipska. Yale Medicine News. https://medicine.yale.edu/news-article/the-price-of-insulin-a-qanda-with-kasia-lipska/.
Miller, K. (2022, October 6). Insulin prices: Pumps, pens, syringes. Healthline. https://www.healthline.com/health/type-2-diabetes/insulin-prices-pumps-pens-syringes#insulin-pricing.
American Diabetes Association. (2023). Affordable insulin initiatives. https://diabetes.org/tools-resources/affordable-insulin.
Greene, J. A., & Riggs, K. R. (2023). Why do prescription drugs cost so much? Annals of Internal Medicine, 176(2), 271–272. https://pmc.ncbi.nlm.nih.gov/articles/PMC10836477/).
Harvard Health Publishing. (2024, January 18). Why do your prescription drugs cost so much? Harvard Medical School. https://www.health.harvard.edu/blog/why-do-your-prescription-drugs-cost-so-much-202401183007.
Kapczynski, A., & Park, C. (2013). Polymaking under uncertainty: Evergreening and drug patents. PLoS Medicine, 10(1), e1001389. https://pmc.ncbi.nlm.nih.gov/articles/PMC3680578/.
