A collage of moneys being crumpled up over shapes of different pills.

Broken Medicine

For Pharma Companies, Killing is Their Business, and Business is Good

Pharmaceutical companies have been hiking drug prices for decades, leaving many forced to decide between basic needs like housing and food, and the medication that keeps them alive.

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“The last time I refilled my prescription for rapid insulin, Humalog, it was $320 per vial, “says Karlynn Holland, the New York lead for T1 International’s #Insulin4All campaign. “Without insulin, I die in a few days to (at most) a few weeks. It is a painful death where my body literally eats itself. The by-products of this self metabolism will make my blood acidic, ultimately poisoning my internal organs to a point where I go into a coma and then die.”

Holland is far from alone in struggling to meet her basic medical needs. The cost of prescription drugs is killing American women. In 2018, Americans spent $535 billion on prescription drugs, a 50 percent increase since 2010; a majority of them were women. A 2018 survey of 1,001 women between the ages of 34 and 64 by the nonprofit Healthy Women found that that 48 percent of women with chronic conditions have difficulty paying for their prescription medicines, and a recent National Center for Health Statistics Data Brief found that women are more likely than men to use “selected strategies” to cut their prescription drug costs, resorting to practices like rationing medication or taking it improperly to stretch out the doses.

For some patients, like those living with Type-1 diabetes, these coping strategies can quickly turn into a death sentence. Insulin prices have risen 270 percent since 2008. In the face of ballooning costs, at least one in four patients with Type-1 diabetics ration their insulin, which has led to an increase in amputations among young adult patients—and a skyrocketing death rate within the community.

High drug prices are killing everyone, of course—especially people who are working class, or poor, or part of any number of other intersecting marginalized communities, like the Black trans women who remain one of the most vulnerable populations in the country. Not only are women and nonbinary people subject to the withering cornucopia of terrible things that may befall a person in a country with staggeringly inadequate health-care coverage, they also have to deal with the dangers that so often come with moving through the world in a non-male body: domestic violence; sexual assault; dangerous pregnancies (a risk that’s infinitely compounded for Black and Indigenous women).

This dire problem is only exacerbated by the fact that prescription-drug costs—formulated by pharmaceutical manufacturers determined to squeeze every last molecule of blood from a stone, or in this case, a human being—continue to rise. In January 2019, drug companies raised prices on over 1,000 drugs, a diverse array of pharmaceuticals including insulin, OxyContin, Metformin, which treats high blood sugar (and whose price got jacked up 148 percent) oral nitrofurantoin, whose price was raised by 400 percent, and physostigmine, a treatment for glaucoma which now costs 100 percent more. This hits women particularly hard. For example, more women than men are prescribed antidepressants across multiple age groups, with nearly one in four women ages 50 to 64 on antidepressants. This latest round of price hikes raised the generic version of Prozac by 568 percent. Type-1 diabetes kills women at a 40 percent higher rate than it does men, and insulin prices jumped again this year.

For these companies, killing is their business, and business is good.

Martin Shkreli, the sneering PharmaBro, made headlines in 2015 for raising the price of the drug Daraprim by 5,000 percent; the drug, which is used to treat the parasitic infection toxoplasmosis in babies and HIV/AIDS patients, climbed from $13.50 per pill to $750 overnight. It was perfectly legal for him to do so, too, due to the lack of any meaningful regulations on how the pharmaceutical industry prices drugs. Unlike in many other countries, in the U.S. drug manufacturers are able to set their own prices, and then hide behind the claim that their high profits are justified by the amount of money they pour into research for new drugs. This is a crisis of government as well as capitalism, which forms the exploitative bedrock upon which this entire system was built.

This is a systemic issue that can’t be pegged to one particularly flawed presidential administration; prescription drug costs have been rising at a shocking pace since 1997, and tripled between then and 2007. Prices rose sharply in 2006, when prescription-drug coverage was brought under Medicare’s umbrella; between 2006 and 2014, prices shot up on an average of 57 percent—and those with no generic substitute ballooned 142 percent. How could that happen? The Byzantine, exploitative machinations of the current U.S. health insurance industry is to blame. When drug companies raise their prices, they reap deeper discounts from health insurance claim processors known as pharmacy benefit managers. These PBMs in turn profit because insurers pay them out depending on how much of a discount they’re able to negotiate with drug companies. This means that it’s in the drug companies’ best interests to keep prices high—and why they keep on hiking up those numbers. It’s complicated and corrupt, and has real-world consequences.

This is also why it’s such a big problem that Trump continues to do his damndest to repeal the Affordable Care Act and gut Medicaid. Given that Medicare and Medicaid are the largest prescription drug clients in the country, any Trumpian threat to the current system would have a nasty impact on those who depend on them for care. According to Timothy Faust, the author of the forthcoming book Health Justice Now: Single Payer and What Comes Next, an ACA repeal would disproportionately hurt women, particularly women of color.

“Medicaid is the primary insurer of poor people; women are more likely than men to be on Medicaid, and people of color are much, much more likely than white people to use Medicaid—poverty is feminized; poverty is racialized,” Faust explains. “Women of color, especially in the South, are more likely to be denied Medicaid altogether (14 states have refused to expand eligibility under the ACA), or face incredible challenges in using Medicaid or other social services programs.”

The Trump administration had made a lot of noise about lowering prescription drug costs, yet has done very little to actually make an impact: 24 percent of Americans currently taking prescription drugs report struggling to afford prescription drug costs, forced to choose between taking their medication or paying their rent, and those who are made to bear the brunt are often suffering from addiction, or living with other chronic conditions. As the country continues to struggle in the grip of an opioid epidemic, prices for anti-overdose drug Narcan surged so much that the federal government had to step in. In 2018, the cost of a lifesaving EpiPen surged from $57 to $317. Insulin users have reported a huge price increase, which had led to a black market of dubiously sourced insulin vials and old pumps.

“For Type-1 diabetics, it is pay for insulin or pay with your health,” Holland explains. “People living with Type-1 diabetes are paying a figurative arm and a leg for insulin until they can’t anymore, and then they pay a literal arm and a leg before they die from complications like kidney disease. It is undignified, cruel and completely unnecessary. We are sick and dying as a direct result of the rising list price of rapid insulin. Exposure to the list price of rapid insulin in the United States is toxic and increasingly fatal.”

“I’ve met families who were thrown into medical debt from complicated childbirths—the debt resembles a kind of negative inheritance,” Faust adds. “Sometimes they can’t even accumulate debt and are flat-out denied healthcare because they can’t afford its cost: their job is to pray desperately, roll the bones on ineffective alternate cures, or slowly wait for death.”

The kind of universal health-care programs that Faust and Holland support—single-payer model, popularly known as “Medicare for All”—have become a massive campaign issue ahead of the 2020 presidential election, with Democratic candidates being called upon to voice their support—or explain their reticence to endorse the idea (it’s obviously not worth putting the question to Trump).

As Faust explains, universal single-payer health insurance would liberate people—all people—from the brutal cycle of rationing health in relation to wealth, “There’s a great irony to this in that it almost always is much cheaper to treat these kinds of problems as soon as possible—we are incurring tremendous medical and human costs over the long-term simply because we insist on this dumb model of private insurance,” he says.” Holland agrees.

“NYinsulin4all supports the New York Health Act, which would provide single payer healthcare to all New York State residents, and we also support nationwide Medicare for All,” she says. “We do not support the protection of pharmaceutical companies who place their profit interests far above the lives of patients. What they are doing is evil, and it is killing innocent people who managed to survive childhood with a very complicated and difficult metabolic condition only to be price gouged to death as adults.”

Despite the urgency (and Medicare for All’s widespread popularity), only a few Democratic front-runners have fully committed to the plan. Sen. Bernie Sanders, who first helped to popularize the idea during his 2016 presidential run, is a big supporter, and is joined by Sens. Kamala Harris, Elizabeth Warren, Kirsten Gillibrand, and Rep. Tulsi Gabbard in a full-throated defense of universal healthcare. Sanders’s plan is heavy on the type of wide-ranging coverage he seeks to provide, but light on financial details—though he makes an explicit bid to lower prescription drug prices. Warren has recently emerged as a leading voice on the issue; she remains a sponsor on Sanders’s Medicare for All bill, but during the first round of Democratic debates, made waves when she called for the end of the private health insurance industry.

Others—like Sen. Cory Booker and Rep. Tim Ryan—have expressed wanting to keep the ACA but waffled on the idea of moving away from private health insurance entirely, and South Bend, Indiana Mayor Pete Buttigieg and former HUD Secretary Julián Castro have remained vague. Drug prices have rapidly become a leading issue in the 2020 presidential race, and while some candidates have been vocal about cracking down on this vampiric industry (for example, Sen. Amy Klobuchar recently rolled out a plan to combat price gouging, and Sen. Warren dropped quite an ambitious, comprehensive plan herself), nothing less than a full commitment to the issue will suffice. For those who are currently without health insurance or struggling to contend with the poor quality plans they have now, political hemming and hawing isn’t going to cut it.

As Faunt says, even Medicare for All is just a start; deeper political issues and the capitalist system at large need to be addressed before we reach any semblance of health justice in this country. “To attempt to repair the ravages of American health care without addressing its underlying questions of financing and privatization is to attempt to put a bandage over a bullet hole. We simply cannot fix only ‘what we have now’ because what we have now is creating the problems we’re concerned about. Brutality and deprivation are not an unexpected side effect of deciding that healthcare should be rationed by income—it’s a natural and predictable consequence.”

It’s become increasingly obvious that expanding health-care access, reigning in the reaches of capitalism, and kneecapping the pharmaceutical industry’s predatory impulses would go a long way towards reducing costs and saving lives in the long run. The question now is how much time we have to waste—and how many more people have to die before we get there.

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