The United States health care system is a business. Providers and policymakers across the country attempt to improve the quality and accessibility of national health care, but the profitability of these services stands in the way. In 2016, the United States government spent more than $3.3 trillion—which is 17.9 percent of our gross domestic product (GDP)—on health care expenditures, $329 billion of that being prescription drug expenditures alone.
Despite this, our health care outcomes do not match our expenditures, largely because over 30 percent of US health spending is wasted, and overpricing contributes to this waste.
Pharmaceutical companies perpetuate overpricing by setting prescription drug prices drastically higher than they need to be, to the point where many citizens cannot afford necessary medications. Pharmaceutical companies overprice their products seemingly without reason or limitations, and their greed can kill. Pharmaceutical greed is a plague on our health care system and an unavoidable death sentence for many. To improve nationwide health, we must make prescription medication readily available to those who need it.
How They Feed: Drug Representatives and their Relationships with Physicians
The United States and New Zealand are the only two countries that allow companies to directly advertise medications to consumers. When prescription drug advertising began, there weren’t many regulations on how companies could promote them. Drug companies didn’t have to provide information about how certain drugs worked, how much they cost, or if there were similar alternatives. Today, still, the FDA doesn’t approve prescription drug ads until they first appear in public.
Direct-to-consumer advertising can be dangerous if consumers lack the proper health literacy to question what is being sold to them. Many believe that consulting their doctor about an advertised drug may protect them from potential harm. Unfortunately, predatory drug representatives are already one step ahead.
Physicians are also prone to fall victim to pharmaceutical advertising. Drug representatives market products to health care providers by forming relationships with them. Companies connect with physicians directly to convince them to market their products to patients, sometimes even sending gifts and free samples. And companies don’t just send their products to any doctor. To target the right specialty and the most-profitable consumers, pharmaceutical companies use prescribing data to track how many patients receive prescriptions for their medications relative to competing products. Pharmaceutical companies also use this information to follow physicians that typically prescribe their products.
There are many reasons why a physician would willingly trust, accept, and distribute a drug that is marketed to them directly. Pharmaceutical companies know that the workload for physicians, especially those with private practices, is intense. More than half of “high-prescribing” doctors look to drug representatives as their main source of information about new medications. Though many physicians benefit from relationships with drug representatives, many are still skeptical of their practices. Physicians ultimately decide which medications to prescribe to their patients, but pharmaceutical companies and drug representatives greatly influence their decisions.
Their Goal: Above Everything, Make Money
Pharmaceutical companies push physicians to prescribe as many expensive drugs as possible. Rather than increasing funds for drug development and improvement, pharmaceutical companies spend much of their funding on advertising. Pharmaceutical company owners are no longer interested in, or arguably were never interested in, providing care. Their main objective is to make as much money as possible, and health care is an increasingly profitable market.
For many life-saving medications, FDA rules enable companies to inflate prices to the highest point that consumers can tolerate.
Drug overpricing not only affects those who are older or chronically ill, but also children. Many children have allergies that, when triggered, require immediate medication. In most cases, children can’t avoid whatever substance triggers their allergies and must carry medication in the form of an EpiPen, which are auto-injectable devices that administer epinephrine to treat severe allergic reactions. The pharmaceutical company Mylan has a monopoly over EpiPens and, in 2016, raised its price to $300 per injector.
This price tag obstructs access to a life-saving medication for those who need it. State and federal lawmakers tried to impose laws that increase EpiPen availability in schools and other public spaces, but its price made it impossible for these institutions to carry them.
As a response to public pressure, Mylan decided to manufacture a cheaper, “generic” brand of the EpiPen, but ultimately did not improve its accessibility. Although the generic brand was seemingly half the price, it was still three times more expensive than the EpiPen’s original price of $50. Today, the average price of a brand-name EpiPen is $690 and generic alternatives match Mylan’s inflated 2016 EpiPen prices.
Pharmaceutical companies know that their products are essential for many of their consumers, preventing them from losing income when raising prices. This was the case for Daraprim, a life-saving treatment that was the go-to medicine for treating toxoplasmosis, a parasitic infection especially dangerous for people with compromised immune systems.
Since it was approved by the FDA in 1953, only one Daraprim supplier existed in the US. Despite this monopoly, each pill only cost $13.50 until the mid-2010s, when the rights to Daraprim were bought by Turing Pharmaceuticals: a company ran by former hedge fund manager Martin Shkreli. Shkreli saw Daraprim as a money-making opportunity and raised its list price by more than 5,000 percent. Shkreli never faced consequences for this outrageous price increase, as there were no regulations in place to stop him.
Today, Daraprim is $750 per pill, which poses a barrier to many. Even with other resources like health insurance, Daraprim is too expensive for hospitals to stock and insurance companies often refuse to pay for it. However, the cheaper alternatives to Daraprim are less effective and come with more side effects.
Dr. Wendy Armstrong, an infectious disease specialist, claims that a rehabilitation facility denied one of her patients after undergoing a kidney transplant because they would not assume the cost of the Daraprim. The high price of Daraprim prolonged the patient’s hospital stay and caused them to suffer further complications.
Symptoms and Side Effects: How Greed Kills
Prescription medications make up around 17 percent of personal health care services. In many cases, people need to sacrifice other essential needs to cover health care costs. And in extreme cases, those who cannot afford life-saving medications go without them.
One of the most notoriously inaccessible drugs on the market is insulin. Most leading insulin manufacturers consistently increase their prices over time, ignoring factors like availability and affordability. In 2017, a group of patients sued Sanofi, Eli Lilly, and Novo Nordisk for inflating insulin prices. The class-action lawsuit states that these companies raised the list prices of Lantus, Levemir, Novolog, Apidra, and Toujeo by more than 160 percent in the last five years, while pharmacy benefit managers are offered constant or reduced prices. Today, patient groups and other organizations still fight for affordable insulin prices.
Lack of access to essential medications forces many patients to look towards alternatives that negatively impact their quality of life. Because of inflated insulin prices, some diabetic patients ration their remaining medication, sometimes reducing or skipping doses. Approximately 25 percent of diabetics ration their insulin doses because of financial constraints. Diverting from treatments without first consulting a physician—another expensive encounter— can be harmful and even lethal.
Without insulin, type one diabetics are at risk of diabetic ketoacidosis (DKA), which kills in weeks if left untreated. Type two diabetics may last months or years with restricted medication access, but a lack of insulin is certain death for those suffering with diabetes. Diabetics who cannot afford insulin must rely on hospital emergency rooms, savings programs, state copay caps, emergency refills, Walmart’s ReliOn brand, and mutual aid to live comfortably. Although there are available alternatives, diabetics shouldn’t have to put their financial security at risk for essential medications.
The Treatment: Accountability
Although other nations struggle with drug accessibility, pharmaceutical greed is a parasite that uniquely feeds off of the American health care system. Drug prices as high as seen in the US are not common in any other country, forcing many to resort to risky alternatives to get the treatment they need. The US spends too much on health care to have citizens crowdfunding, rationing, or simply succumbing to their illness due to medical inaccessibility.
This greed is at the expense of our economy. Outside of health-related consequences, national health care expenditures increase at a rate that surpasses GDP. This rapid growth is unsustainable since many Americans need to spend their income on medical expenses, leaving little room for other forms of consumption. As a result, pharmaceutical greed crowds out other businesses.
The needless overspending and overpricing is dangerous and often deadly. Pharmaceutical greed is ingrained in the health care system, so addressing and undoing its damage will be difficult. To improve medical accessibility, we must hold pharmaceutical companies accountable for their actions and prioritize improving nationwide health literacy.