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The truth behind why Daraprim can cost whatever its CEO wants it to

Five reasons drug companies are getting away with charging a fortune for needed medications.

A greedy, cocksure CEO set off a nation of people tired of mysterious and unchecked drug pricing.

Have you ever suspected that drug manufacturers have been given complete license to charge whatever they want?

You wouldn't be wrong.


Since he got us talking about this, we have to thank Turing Pharmaceuticals CEO Martin Shkreli. He raised the price of the drug Daraprim from $13.50 to $750 per pill.

The justification for the cruel hike?

"It's a more appropriate price."

GIF from CNBC.

What does that even mean? How does a drug manufacturer decide what is an appropriate price?

Well, there are a lot of missed could-be checkpoints in the American health care system that give manufacturers utterly unfettered license to charge whatever they decide.

A quote from The Economist puts into sharp perspective just how ambiguous the process is: "One economist at a closed-door session of pricing experts at [the American Society of Clinical Oncology] dryly remarked that she could find no economic theory to explain how companies price their drugs."

As Jessica Wapner, a researcher and writer on biomedical issues, puts it in her blog: "Drugs cost what the market will bear. It's that simple. Drug prices are set at whatever the market will bear."

Here's why.

Price Gouge License #1: Pharmaceutical companies can advertise directly to Americans, unlike in many other countries.

Image by Pfizer.

In the 1980s, pharmaceutical companies were growing tired of doctors being the gatekeepers between patients and newly available drugs. The first commercial marketed to the general public was in 1986 for Seldane. The profits for Seldane soared beyond anything the marketing team had imagined, and other companies soon followed suit. And in 1997, the FDA further loosened its rules on television ads for prescription medicines, which truly opened the floodgates.

FUN FACT: The only two developed nations that allow this kind of "direct-to-consumer" drug advertising are the United States and New Zealand. It is specifically banned in other countries.

Price Gouge License #2: The pharmaceutical industry has a distinct lack of competition, and in fact is monopolistic by design.

Innovation needs to be rewarded, goes the reasoning. And that point is easy to see. Without some incentive, there are a lot of lifesaving and quality-of-life-changing drugs that would never have been invented.

The good old days. Image via March of Dimes.

But it also stands to reason that innovation can be rewarded at scale and for a finite time, not at ever-increasing margins forever and ever. That's just not sustainable, and it practically begs for some intervening agency to act. As drug companies look for more ways to expand their profits each year — 73% of Americans polled in 2015 already think drug prices are too high — something has to give. Profits can be had, and even attractive ones at that, without carte blanche for the kinds of excesses we're seeing:

"Gleevec, from Novartis, possibly the greatest cancer drug ever invented, cost $24,000 a year when it was introduced in 2001; now it costs $90,000 per year, a quadrupling in price." — "60 Minutes" via Forbes, 2014

FUN FACT: According to a Kaiser Foundation report in 2005, 10 pharmaceutical companies accounted for 60% of U.S. pharmaceutical sales in 2004. It's as if a cluster of multinational corporations have an unwritten understanding that they can just stay in their lanes and get while the getting's good.

Price Gouge License #3: The complicated insurance setup in America gives manufacturers an advantage versus a single-payer situation where prices can be negotiated.

Image via iStock.

Other countries with socialized, single-payer health care systems are able to negotiate prices with drugmakers. Since all the power is collectively concentrated in the one single-paying entity, it forces the drug companies to play nice — or at least act in good faith.

FUN FACT: In 2003, a new act meant to "modernize" Medicare and bring prescription coverage into the mix prohibited Medicare (the largest customer in the American drug industry) from being able to negotiate prices with drug companies.

Price Gouge License #4: There are complex, private pricing strategy sessions that don't get revealed to the public.

We all know what happens when the process of how the sausage gets made never sees the light of day. It can result in some pretty rotten stuff being channeled to consumers.

But Jessica Wapner sheds a little light on what factors come into play in these sessions:

  • How many patients are buying the drug
  • How many are likely to be insured privately or through the government, or are uninsured
  • Length of an average treatment course on the drug
  • How high the stakes are for what the drug treats (desperately needed or only mildly beneficial)
  • How many years the drug will have exclusivity in the market (meaning no generics)
  • Budgeting for patient assistance programs ("If you can't afford your medication, drug company X may be able to help")

That's right. Those drug assistance programs aren't a kindly, out-of-their-own pockets, benevolent gesture. The companies get their money for them — they just tack it on top of what they're already charging.

FUN FACT: There are special forecasting companies that help drug manufacturers evaluate the field and arrive at complex equations regarding prescription prices.

Price Gouge License #5: Many consumers are shielded from the reality of drug prices because of insurance.

That means they keep buying the drug even if their copays go up (making concessions in other parts of their budget as long as they can), which reinforces to the manufacturer that their pricing practices are working. People will just pay it. They will find a way. And though some can't or don't find a way — and sometimes wind up giving up lifesaving drugs out of financial defeat — the sheer numbers don't usually rise to the proportions needed to signal to drug companies that they've made a pricing error.

Because they're still making a profit.

The highest performers in the health technology category in 2015 were Pfizer, Merck, and Johnson & Johnson.

Image via Forbes with permission.

Is there any good news out of all of this?

Yes! Increased attention on drug prices during the last year is culminating in a lot of "we're not gonna take it" talk from politicians and the media. President Obama is attempting to get Medicare negotiation rights for the most expensive drugs.

And I'll say it again: We should thank Martin Shkreli for his severe overreach in pricing Daraprim because it refocused the nation on a huge problem we've all lived with for far too long. I doubt he's very popular with his industry brethren right now — they avoided pitchforks for a long time before he came along. And in response to the public's backlash and, I'm personally betting, pressure from within an industry anxious to avoid intervention, Shkreli did finally say he will reduce the cost.

The pharmaceutical industry is banking on being too difficult to figure out for the average Joe to fight back against. That's why it's important to share this and get people thinking.

The price of drugs, if left unchecked, will eventually debilitate us.

It doesn't have to be this way.

All images provided by Prudential Emerging Visionaries

Collins after being selected by Prudential Emerging Visionaries

True

A changemaker is anyone who takes creative action to solve an ongoing problem—be it in one’s own community or throughout the world.

And when it comes to creating positive change, enthusiasm and a fresh perspective can hold just as much power as years of experience. That’s why, every year, Prudential Emerging Visionaries celebrates young people for their innovative solutions to financial and societal challenges in their communities.

This national program awards 25 young leaders (ages 14-18) up to $15,000 to devote to their passion projects. Additionally, winners receive a trip to Prudential’s headquarters in Newark, New Jersey, where they receive coaching, skills development, and networking opportunities with mentors to help take their innovative solutions to the next level.

For 18-year-old Sydnie Collins, one of the 2023 winners, this meant being able to take her podcast, “Perfect Timing,” to the next level.

Since 2020, the Maryland-based teen has provided a safe platform that promotes youth positivity by giving young people the space to celebrate their achievements and combat mental health stigmas. The idea came during the height of Covid-19, when Collins recalled social media “becoming a dark space flooded with news,” which greatly affected her own anxiety and depression.

Knowing that she couldn’t be the only one feeling this way, “Perfect Timing” seemed like a valuable way to give back to her community. Over the course of 109 episodes, Collins has interviewed a wide range of guests—from other young influencers to celebrities, from innovators to nonprofit leaders—all to remind Gen Z that “their dreams are tangible.”

That mission statement has since evolved beyond creating inspiring content and has expanded to hosting events and speaking publicly at summits and workshops. One of Collins’ favorite moments so far has been raising $7,000 to take 200 underserved girls to see “The Little Mermaid” on its opening weekend, to “let them know they are enough” and that there’s an “older sister” in their corner.

Of course, as with most new projects, funding for “Perfect Timing” has come entirely out of Collins’ pocket. Thankfully, the funding she earned from being selected as a Prudential Emerging Visionary is going toward upgraded recording equipment, the support of expert producers, and skill-building classes to help her become a better host and public speaker. She’ll even be able to lease an office space that allows for a live audience.

Plus, after meeting with the 24 other Prudential Emerging Visionaries and her Prudential employee coach, who is helping her develop specific action steps to connect with her target audience, Collins has more confidence in a “grander path” for her work.

“I learned that my network could extend to multiple spaces beyond my realm of podcasting and journalism when industry leaders are willing to share their expertise, time, and financial support,” she told Upworthy. “It only takes one person to change, and two people to expand that change.”

Prudential Emerging Visionaries is currently seeking applicants for 2024. Winners may receive up to $15,000 in awards and an all-expenses-paid trip to Prudential’s headquarters with a parent or guardian, as well as ongoing coaching and skills development to grow their projects.

If you or someone you know between the ages of 14 -18 not only displays a bold vision for the future but is taking action to bring that vision to life, click here to learn more. Applications are due by Nov. 2, 2023.
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