Medicare Drug Pricing Negotiations Advance

Alex Lawson and Ryan Grim discuss the decadeslong struggle against Big Pharma to lower drug prices.

An insulin pen manufactured by Novo Nordisk is displayed on March 14, 2023, in Miami. Photo: Joe Raedle/Getty Images

Insulin, the lifesaving drug for tens of millions of Americans, is among the 10 drugs Medicare will negotiate for lower prices, by the power vested in the White House through the Inflation Reduction Act. This week on Deconstructed, Alex Lawson, executive director of Social Security Works, joins Ryan Grim to discuss the decadeslong struggle against the pharmaceutical lobby to lower drug prices and how the Biden administration secured Medicare drug pricing negotiations. Grim and Lawson discuss the pharmaceutical industry’s enormous power, their aggressive efforts to stop the legislation and water it down, the history of political infighting and betrayal that led to this moment, and what the future of drug price negotiation may look like.

[Deconstructed theme.]

Ryan Grim: I’m Ryan Grim, welcome to Deconstructed.

This week, the Biden administration announced it had finalized the list of the first ten drugs that Medicare would begin price negotiations over with Big Pharma. And it pleasantly surprised healthcare reform advocates by including short-acting insulin on this list of blockbuster drugs.

That we had to have a 20-year long battle, simply to allow the government to do what basically every other government is already doing, is itself a scandal. Yet, this also represents a major victory. And those are very hard to come by against Big Pharma.

Democrats have publicly opposed the law that blocks Medicare from drug price negotiations, since it was implemented by a Republican majority back in 2003. But they’ve only held the White House, Senate, and House at the same time for two cycles since then. They failed to get it done the first time, or — I should say — they deliberately failed to get it done the first time. But this time, they pulled it off.

Alex Lawson is the executive director of the organization Social Security Works, which has been fighting Big Pharma on this issue for years now. I’ve known Alex as one of D.C.’s most dogged public advocates for around 15 years and he and I co-founded the small progressive publishing house Strong Arm Press back in 2017, and we published my book “We’ve Got People” back in 2019.

Speaking of which, I have a new book coming out this December, this one published by Henry Holt, called “The Squad: AOC and the Hope of a Political Revolution.” It traces the evolution of the left from 2015, starting with Bernie’s first campaign, through the 2022 midterms. It’s essentially a sequel to my last one and you can preorder it now on all the book platforms, including independent ones. Preorders are hugely influential to how a book does on launch, so if you liked the last book, or you enjoy this podcast, please consider preordering. Alex is actually a character in the book and it tells the story of the blowback he took from the party establishment for his organization’s relentless push on drug pricing.

The dramatic fight to get where we did this week took a lot of twists and turns. Yet despite Pharma spending more than $700 million, here we are. To tell the story of how the public won this small but significant victory, Alex joins us today.

RG: Alex Lawson, welcome to Deconstructed. Thanks for joining me.

Alex Lawson: Thanks for having me.

RG: So, how long have you been working on this? Not as long as Billy Tauzin has, am I right?

AL: Not quite as long. A decade, a little over a decade and a half.

RG: Yeah, tell us a little bit about that Louisiana congressman, and how we wound up in this situation where it took a fight to allow Medicare to actually negotiate with drug companies for bulk drug purchases.

AL: I say this not being a full student of all of the corrupt history in this town, but I can name quite a few episodes, like the teapot dome scandal, and things … and, still, the Billy Tauzin sellout is at least top three, especially for its [blatancy].

So, this is a guy, he’s from Louisiana, he was a Democrat, he was elected as a Democrat. He rose through the power structure to chair a really critical committee that has jurisdiction over Medicare, specifically where Medicare Part D is created. And he is literally like a guided missile; the reason he’s doing this is to deliver for Pharma.

The Democrats actually lose the gavel. So, they lose power, the Republicans take over. He just switches party, just [moves] right over. He’s like, no, I wasn’t with those guys, I’m with Pharma. [All] so that he could stay on that committee, and he had one goal, and it was to insert what’s called the noninterference clause. And all that says is that Medicare cannot use its purchasing power to negotiate a lower rate. So, even though Medicare is the largest purchaser of prescription drugs on the planet, it can’t use that to get a lower rate on those drugs that it buys.

This is during the creation of Medicare Part D, which is a good thing, right? It’s good that prescription drugs are covered in Medicare because, obviously, prescription drugs are part of healthcare.

RG: Some of our listeners, who are as old as me and you, might actually remember this vote. It was before I was professionally involved in politics, before I was a journalist, but I remember it happened at, like, five in the morning. It’s around 2003, 2002, something like that, and you had Republicans pushing a gigantic entitlement benefit.

And I remember thinking, why are Democrats against this? This seems great. You know, it’s terrible that it’s a big giveaway for pharma, but I’d rather have the government wasting money on harma and people getting medicine than people not getting medicine.

So, how did it happen that Democrats wound up kind of opposing this? And I remember Tom DeLay was sending the Capitol Police after Republicans who had voted the wrong way and left, and he [was] like, physically dragging them back and getting them to change their votes, and kept the vote open for, like, five hours or something like that, until the early morning, until he and Billy Tauzin were able to break enough arms that they passed it by, like, one vote.

And then, seniors got drug coverage. It’s totally a bizarre through-the-looking-glass kind of moment.

AL: I think it is. I think it’s one of those ones where, in the sort of… The day-to-day, the Democrats were seeing that this had this fatal flaw in it, and that when they took power, they would have a drug plan that wasn’t a giveaway to pharma. I don’t want to be, like …. This might be the right podcast for it, but it feels sort of like when Richard Nixon put in the price controls, right? When Richard Nixon literally took the left economists’ playbook, and did it, but didn’t do it super well.

And, also, it was to put them in a pretzel, it was actually to put the Democrats in a pretzel. Meaning, they were put in a position where they weren’t the ones fighting for the Medicare expansion, even though that is what they do, and the Republicans are always fighting against it. And then, as soon as they got the power, they were like, oh, I’m going to take this one super-popular thing that you have, and I’m going to do it, but I’m going to carve into the middle of it this massive handout to industry, and that’s the Tauzin giveaway.

And then, sticking the landing there, for Tauzin, is really the most amazing part. Because he almost immediately leaves government and takes a $2-million-a-year job at PhRMA, the lobbying organization for the pharmaceutical industry. It really was a well-constructed play on the side of the Republicans, because it did put Democrats in this tough place where they’re like, “Hey, that’s unfair, you’re taking our issue but making it worse,” right? I do think that that’s a long-running tactic in politics.

RG: And this is the right podcast for that, because we just had Jamie Galbraith on here about a month ago talking about the history of price controls. So, totally fair. And, actually, they outlawed what Tauzin did after he did it, when Democrats came back into power after 2006 they put in place rules that say you can’t actually pass a law that gives billions of dollars to the pharmaceutical industry, and then, like, within a week, resign and take a job for millions of dollars running the lobbying arm for the pharmaceutical industry.

He didn’t even do it in a clever [way], like, I’m going to be a consultant on the side for them. Like, they made him the president of PhRMA.

AL: It was a flex, right? I mean, and the rules, they actually … They’re get-around-able, right? The revolving door has not been stopped. I don’t even think it’s slowed down. You just can’t do it and also flex, point at your bicep, and be like, “You see what I did there? Yeah, that was me!”

RG: And then he turns out to be the guy who’s then sitting across the bargaining table with Barack Obama’s team in 2009. He’s the pharma guy who then cuts the pharma deal.

Talk a little bit about the 2009 pharma deal, and then we’ll get up to what we got this week.

AL: Yeah, happily, but I’m going to do it through the lens of me, Alex Lawson, just so that you can hear it. Because it was a really interesting D.C. moment for me.

So, I don’t come to this through politics. I was working in an outreach HIV clinic in Chicago, and then an outreach HIV clinic here in D.C. And in those positions, it was actually in Chicago that I was like, why is everything so stupid? Like, why does nothing work? And everyone’s like, ah, it’s policy. And I’m like, what is this policy stuff?

And I kind of knew, but, in looking into it, I was like, yeah, I’m going to go get my master’s in policy in Washington, D.C., and then I’m going to work to dismantle the pharmaceutical industry, and build something based on public health in its place. Because right now it makes absolutely no sense. I’d have clients — we have the drugs. This drug will keep this person alive. Why can’t I just give this drug to this person who needs it? And they’re like, well, yeah, you can’t. It’s policy, who’s going to pay for it? And I’m like, that doesn’t even make any sense!

And it was during a real high point in the global fight against HIV, when South Africa, and Brazil, and others were working together to circumvent pharma, who was saying these antiretrovirals cost $10,000 per patient per year. And everyone’s like, no, they don’t. They cost literally pennies to make. They don’t cost that much, you just charge that much.

So, I was steeped in activism, and some really beautiful successes that I won’t talk about here. But I literally moved to D.C. to get my master’s in policy, to work on punching pharma in the face with public health-driven policy. And then I see an opportunity to actually do that, getting involved in the push for Obamacare. So, I start working in the policy of an outside organization — Healthcare for America Now — that’s pushing for Obamacare. And I’m like, I am ready to go, let’s do this.

Two weeks in, they come in and they’re like, hey, guess what? Guess who we cut a deal with? We just got news from the White House, they cut a deal with Pharma. They’re not going to attack it. Pharma’s not going to attack Obamacare. And I was like, oh, no. That’s terrible! Terrible. Don’t make a deal with those guys!

But they did. And you’ll still find a lot of people who will defend it. I openly am like, that’s literally one of the dumbest things that I’ve ever seen a Democratic administration do, because it was so cheap. They got hundreds of billions of dollars for $150 million in advertising money. And then the lie that Pharma wasn’t going to run any ads against any of the Democrats.

To trust Pharma, in the first place, is one of the silliest things that you could ever do. So, they got everything they wanted, which was [that the] government, literally, for eight years, at the federal level, did basically nothing to bring down the price of drugs, to attack Pharma’s concentrated pricing power, its monopoly power. And this is sort of heterodox but widely held in the HIV activism community point of view, which is that, in the end, with the creation of PEPFAR, G. W. Bush — who, you know, I used to get arrested in front of the White House on World AIDS Day every year — he did more for global HIV access than the Obama administration did. The Obama administration wasn’t all bad or anything like that, and Obamacare, the expansion of Medicaid, is a fantastic policy outcome, I’m very proud of it.

But the idea that you could make a deal with Pharma, and that that wouldn’t make you complicit in acts of overt evil that are beyond many people’s comprehension of how bad this industry is.

RG: Right, we talk about Martin Shkreli, or however you say his name, everybody agrees that he’s evil.

AL: And you know this, Ryan. You know who — the only people who hate him more than me are the actual captains of the big pharmaceutical corporations, because they’re like, bro, you blew up our spot, we’ve been doing that for decades! And then you go and buy the Wu Tang album, and then all of a sudden everyone knows that what we do is find life-saving drugs and restrict access for them.

RG: Yes. He just did it with a smirk, and did it kind of flamboyantly.

And so, the win that you guys had this week kind of has its roots, also, in the Trump era fights. So, Trump surprisingly takes power in 2016, beats Hillary Clinton — who had her own pharma plan — but he’s this populist guy who understands that people don’t like paying high drug prices. And so, he talked a big game about doing something, both legislatively and also through executive action.

Why didn’t anything end up happening? Or did he do a little something around the edges? What were those four years?

AL: So, it depends on what sort of brand you see Trump as, right? He’s not a dumb person, so it’s not just like, oh, he just couldn’t figure it out. But he really doesn’t care. He got the politics pretty well, but Mitch McConnell drives the boat. Mitch McConnell’s not going to allow anything to happen legislatively.

If you want to go back and look, Chuck Grassley worked with Ron Wyden in finance, and Chuck Grassley actually came… I mean, there was legitimately a good bill that was created in a Republican committee, and more optimistic people than me were like, oh, man, it’s, it’s happening. And I’m like, there’s zero percent chance that’s going to happen. Mitch McConnell will never allow — Grassley is as far as it’s going to get. And that’s exactly the case. That’s what happened. So, on the hill, there was no way McConnell was going to let anything happen.

And then, industry is really smart, so they got in Trump’s ear, and they put one of their guys… Literally, he used to run one of the three insulin cartels, Alex Azar, and he was the guy in charge of it. So Trump could say, hey, I want to do these things, and then it would go to a literal pharma executive, who’d be like, “We’re working on it boss. Night and day, boss. We’re getting right to it. You keep on telling those people, and pretty soon we’re going to deliver those lower drug prices.”

That’s actually what I think generally happened, is that Mitch McConnell was never going to allow anything. And he still will never allow; if he has the ability to kill anything for pharma, he will, that’s one of his main jobs. And then, on the executive side, Donald Trump, it wasn’t one of Trump’s key issues. It was actually like he knew it was an applause line, and so all he needed to do was say he was working on something, and then Alex Azar and his ilk would create enough paperwork that it looked like something was happening.

And there were some rhetorical victories. For example, for me, I’ve been calling for, and we’ve been writing policy on international reference pricing for a really long time now. Trump had it totally inverted, right? He’s like, we should make everyone else pay more. And I’m like, there’s the other way: we could just pay less. They don’t have to pay the dumb amounts that we do. But that was the most favored nation.

So, it never really happened. That’s also a hallmark of Trump, right? Like, he really cared more about the soundbite than the actual policy follow-through. And industry was right there to ensure that he didn’t accidentally do anything that hurt their bottom line.

RG: I remember talking to you a lot in 2018, and then 2019 after the Democrats took control of the house, and there was a big knockdown drag-out fight in the house. Even though it wasn’t going to become law, it seemed like that jockeying still mattered.

What was going on over there?

AL: I would say that that was actually the start of the policy battle and the policy process that ended in the IRA, what we’re talking about currently. Then, it was about defining what Medicare negotiation was going to look like, and I can get into the super-weeds of it, or just say there was sort of a “let’s do a lot.” That’s my side: “Aim high. It’s all going to get watered down and no Republicans are going to vote for it anyways.” And then there’s another side that’s like, “Aim low. Let’s go ask the least terrible Republican and the worst Democrat to come up with an idea.” And they’re like, oh yeah, well, let’s do nothing and call it binding arbitration.

And it was a bruiser of a fight. I won’t relive all of it, but I’ve got the scars to prove it. And in the end, we did win. HR-3 is the end product of that and that bill is really solid policy on what you could do to lower prescription drug prices. And that was the starting point of Build Back Better.

So, my theory — you know, patting myself on the back here — but my theory, which was contested at the time, was that we had to aim as high as possible, and then it would just consistently get watered down at each step. And if we didn’t aim high enough, what crossed the finish line would not hit pharma at all, and we would have had a big fight for no outcome at all.

And I was proven right. Build Back Better started at H.R.3, that’s the bones of it, along with some really great stuff. What Ron Wyden was working on with Grassley, the Ron Wyden part of that and H.R.3 sewed together are the starting point of Build Back Better.

Ron Wyden was the one who brought in that you can’t raise the drug price faster than the rate of inflation. And, if you do, you claw it back. And that’s just brilliant policy, so that you don’t just negotiate a lower price, and then pharma is like, well, now I’m just going to jack it up.

So it was the two sides of it together that yield a working policy.

RG: And so, that doesn’t seem controversial at all to me, it seems obvious. But what was the counter argument? That if you put something that’s too aggressive up front, that it’ll just die immediately? Like, don’t scare them?

AL: Yeah. It’s always like, oh, well, this will never get a Republican vote. And I’m like, correct! Correct! It will have to pass with no Republican votes. So, let’s make sure that it’s something that actually delivers for the American people, and that’s recognizable. And I will say, there were a ton of allies on my side, it’s not like it was me carrying the stone alone.

A lot of our allies on the hill were like, yes, because what happened with Obamacare was that it took, like, a decade for people to actually realize that they liked Obamacare. And then they’re like, oh, man, I really like Obamacare. But, by then, it had been used as a political cudgel to great effect. So, the idea of making sure that it’s strong enough that it helps people, and it’s recognizable. So, Medicare negotiation is super recognizable. People have been fighting and calling for it since 2006 or before.

So, yeah, the controversy was one of these ones that I didn’t understand. I was like, why is everyone fighting about this? It’s so obvious. And then, I will say, in the end, we… Actually, if you want to hear, because this is your podcast… The big thing is, it was the Pharma Dems. So, the people who said it wasn’t as much about getting a Republican vote as it was about getting past potential blockades of Pharma Dems who controlled key committees.

RG: Like, Scott Peters is going to block this if …

AL: Kurt Schrader, Scott Peters. They’re on E&C. If we don’t listen to them, they’re going to kill it in committee, and we’ll never be able to get it to the floor.

RG: It’s the Energy and Commerce Committee, for the non-hill-heads. And they didn’t in the end because they lost, but they did pull out some stops here and there.

Yeah, what did Peters and his friend Kathleen Rice, how did they manage to get themselves into a position to block this?

AL: So, this is a great little story.

We know Kurt Schrader, we know Scott Peters, and we know the Pharma Dems, and we know that Pharma is going to try something, but we are looking at our numbers, and we’re like, we can get through this committee. Like, who else? So, a lot of what we push is, we’re like, if somebody sides with Pharma, we’re going to hit them so hard that we might not move the Pharma Dem, but if there’s any Pharma Dem-curious folks out there, we’re going to actually send a message to them that they will lose their jobs if they bottle this up, if they kill it. And Kathleen Rice was the one that we didn’t see coming.

So, that was this really beautifully executed move by Pharma, where they had this previously non-Pharma Dem — to put another layer on it, and you reel me in, Ryan, if it’s too much — but, actually, Nancy Pelosi, Speaker Pelosi at that time, had pulled some strings or flexed some muscle to keep progressives off of E&C, and Rice was one of her people that she put on E&C.

RG: In lieu of AOC, right? Because it was a fight, because there was one New York Dem that could get on to Energy and Commerce, and both AOC and Rice were gunning for it.

AL: Exactly.

RG: Rice got it over AOC, and then, at the very end comes in. Apparently she became really good friends with Peters. Did you ever hear about how you guys missed the Rice vote? Because she beat it by one vote, right?

AL: Yeah. They carved out a ton. That’s where they drilled most of the most damaging holes that downgraded H.R.3, which had passed previously, and with their votes. So, that is important.

And none of them wanted to lose their jobs. We made sure that two of them did, and the third was just because we haven’t… It’s a top-two primary, and we’re still coming for that one. I have a long memory. But it was a really well executed one, and I think it’s power and influence. And yeah, maybe the members became friends, but then, pretty clearly, Scott Peters introduced Rice to his friends, who are the fancy guys in the very expensive suits who have unlimited money, and they work for Pharma. And they’re like, hey, have you thought about teaming up with our two guys and trying to kill it in committee?

RG: And she had other ambitions. She was running for, what was it, governor or attorney general of New York?

AL: I can’t remember, other than statewide.

RG: Well, she needed a lot of money.

AL: But her huge miscalculation is just how bad everyone hates Pharma. And that knifing Speaker Pelosi in the back the way that she did would cut her off of a lot of power centers as well. Progressives were never going to like her, but like now they hated her, a lot of establishment also hated her. I think it was a clear miscalculation, because she lost her job and did not advance in her career.

But that was the [one]. They tried to kill the whole thing in committee, and the entire weight of Speaker Pelosi’s apparatus, and everything that outside groups could bear, establishment groups, everybody, the entire Democratic movement being like, if we can’t get this thing, this is the legislative accomplishment. This is the trifecta. They’re spending all of the political capital on the Inflation Reduction Act. If you kill it, there is no other thing that’s moving.

And that weight and activism, both on the inside and the outside, was able to rescue it and keep it moving forward, but it did take significant hits. And they were almost fatal, but they weren’t fatal.

But I will always hand it to Pharma, because it was like, no one saw Rice coming. We knew they were going to throw something at us, we didn’t know it was going to be Rice.

RG: Did that end up watering it down at the end?

AL: Yeah. That’s definitely where they drilled the most.

So, basically, in policy land there’s all these levers that you can dial up or down, and in this case, it’s like, how many drugs, and is there a lead-in, does it start right away? And the big ones there, they were drugs that the corporations had already had a bunch of years to make money on, so Pharma was not hit nearly as hard as they could have been, but still, the rip off is so high that even with the watering down or drilling the holes in it, it still delivers.

And that’s sort of making my strategy make a ton of sense, that you needed to start so high, that when Pharma came after it, you had to be like, “and take every CEO’s limousine.” So that when they did their maneuver, they pulled out the most offensive parts to them, but the majority of it kept moving. And that’s what happened.

RG: And so that’s how you wind up with the bill being written saying you can negotiate ten drugs starting in 2023, another 15 the year after, 15 after that, and then 20 every year after that. The negotiations that are announced at the end of next year, and then they go into effect January 1st, 2026. So, it’ll be a little while until you see some of these discounts, but this week they announced the ten drugs that are on the list.

AL: Right.

RG: What was your reaction to that list?

AL: It was a great list, and we can delve into the individuals. But I will also say that there was another thing that happened with the announcement, which is that it also meant that the agency, the department within CMS, was fully formed and operational, right?

So, this was a fully operational Death Star aimed at Pharma. And that was important, because the lawsuits — all these pharmaceutical corporations have sued to try to stop it, and they’re trying to stop it before it gets moving, before the bureaucracy is created with a mandate of delivering a fair price to the American people, and they failed, because that bureaucracy exists. I met a bunch of the people who work there, and they delivered a list of ten drugs. That’s a work product from this new part of the federal government, and that’s what Pharma was so scared of happening, because it’s hard to put the toothpaste back in the bottle when it comes to creating something in the federal government that has a mission, and is creating work product. It’s very difficult for them to get rid of it. It’s not like they’re not going to try.

Then, the drugs that are on the list are all great, they were all pretty much the ones that everyone had known, because it was based on math. They had to be the drugs that are the biggest rip offs. These small amounts of drugs account for enormous percentages of Medicare Part D spending. So, these ten drugs account for just over 20 percent of the total spending in Part D, which is why… You know, I want all drugs right away, but the fact that you have to start with ten and then it grows over time, and it is cumulative, is not the worst thing, because it really is this small number of drugs, and only a few years in, we’ll be hitting a bunch of them.

But there was one that we didn’t expect, which was, insulin was on there. I would say that I think there are some researchers who got 9 out of 10, but no one got 10 out of 10, because insulin was included on there. And that was a huge victory, I think, and really a testament to just decades of activism. And also, a lot of credit to the Biden White House, and everyone who worked in this new department, understanding that they couldn’t play by Pharma’s rules and pretend that we don’t know what we mean when we say “insulin.”

Insulin is unaffordable, and what we mean is everything that’s necessary to keep someone alive, and that’s how they looked at it in the correct way, the way that everyone means it. And by doing the common-sense thing, there’s insulin right on the list and it’s going to save Medicare an enormous amount of money, it’s going to save people an enormous amount of money.

RG: So, let’s say you’re not on Medicare. How does this benefit you? How does it trickle down, so to speak?

AL: Yeah, I wish it was more, I wish it did more.

So, there’s two things that I’ll point out here. One is that, in the Inflation Reduction Act, people on Medicare have an out-of-pocket cap on insulin already, it’s going into effect next year. So they’ll never pay more than $35 on any insulin product. But what that means is that the federal government is just paying, so taxpayers, are just paying the difference between the price and $35. The individual, the beneficiary, is protected.

What negotiating does is it lowers the price itself. So, then you lower it down, and, obviously, the maximum fair price on insulin is going to be $35, because it’s already been well established. By lowering that price that Medicare pays, the way the health system and all other avenues works is, the Medicare price is the bar that everything else is measured off of.

So, if you just think of it as another payer is a for-profit commercial plan, is like, hey, insulin manufacturer, the government is paying you $35, I’m definitely not paying you $350, right? Like, there’s no way I’m paying you $350 if the maximum fair price is $35. And there’s people who are like, why am I paying $355? And we’re like, yeah, exactly, why are you paying $355? It should definitely be $35.

It is a bit of economics and it’s a bit of people power. I wish that we were able to get the prices directly into the commercial market. In H.R.3 that was actually one of the most exciting pieces of H.R.3 — the original bill that we had just talked about — is it included the commercial market. That was stripped out, and that was a parliamentarian strip-out. You’re like, oh man, the totally made up thing. But so is the senate, so, there you go. Everything, it’s all made up. But it does not do nearly enough.

And then to really put the finest point on it, the people who are dying … And I wrote a bill a long time ago, The Alex Smith Emergency Insulin Access Bill. I wrote with Senator Franken’s office. The point of it is that people die because they can’t afford their insulin and the people who are dying are uninsured people. Actually, the nexus was, generally they were 26-year-olds who are type-one diabetics, and that’s when they came off of their parents insurance.

And it’s really that, at that particular moment, it’s difficult to find your own insurance. Maybe you’re not super employed, right? So it’s like, there’s all these 26-year-olds who are dying because they can’t afford their insulin, and the policy response to that is to just buy those people insulin, right? Like, you just make sure that at the point of sale, it’s never possible that somebody can’t afford their insulin. Because if you need insulin and don’t have it, you have hours to live, right?

And I won’t go down a bunch of policy solutions there, but there has been some great work at the state level that’s built on that idea, right? That you just have a program that makes sure that there’s emergency access to insulin. The other way that you can do it is you just lower the actual price of insulin all the way down to it being affordable to people. And then you still probably need some sort of emergency access program. We have done that in Medicare, or it will be done in Medicare on one of the three.

So, you can see, for how many words it’s taken me to explain this, we’ve still got a long way to go. But I am also here to tell you that you shouldn’t think that then it’s meaningless, because these corporations have never lost, they’re just starting to lose. And I saw this, to go back to the beginning.

Remember HIV drugs used to cost $10,000 per patient per year, and we were like, no, they don’t. And then, countries working together, Brazil and South Africa, were like, no, they don’t, we’re just going to produce generic versions of this. And then they did. And then the pharmaceutical corporations were like, all right, just kidding. Ha-ha-ha, it’s a hundred dollars per patient per year. And across the board, all of a sudden, it went from, all of these people have to die because we can’t afford antiretroviral drugs to, actually, we can afford it all, and we’ll create the PEPFAR, the Presidential Emergency Plan for AIDS Relief, and just buy everybody the treatment that they need.

And Pharma actually wins in that case, too, you know? Like, they’re not going out of business. That’s the immense amount of greed that I don’t think people understand. They win on both sides. Even at the lower price, they’re still making oodles of money, it’s just that they care so little for the carnage that they want to charge $10,000.

Once the price breaks, it really does have a tremendous effect, and it sort of reverberates across the system. So, all of the antiretrovirals sort of fell at one time, back in that era. We don’t know exactly how hard the downward pressure on prices and the commercial market is going to be. There are people who are a lot smarter than me who say it’s going to be a lot, and then there are people who work for Pharma who say it’s not going to do anything at all. And you’re like, well, then why did you spend all that money trying to stop it?

RG: Yeah, not sure I believe that.

Well, it’s nice to see the industry on the run at least, Alex. Thanks so much for joining me, I really appreciate it.

AL: Thanks for having me.

RG: That was Alex Lawson and that’s our show. One quick note: Kathleen Rice was widely expected to run for Attorney General in New York to replace Tish James, who had launched a run for governor. And Rice was included in hypothetical polls. But James ultimately dropped out of that gubernatorial race and ran again for AG, which led every Democrat to drop out or take a pass on running against her, so Rice never officially ran. She still left Congress and she holds no elected office today.

Deconstructed is a production of The Intercept. Our producer is José Olivares. Our supervising producer is Laura Flynn. The show is mixed by William Stanton. This episode was transcribed by Leonardo Faierman. Our theme music was composed by Bart Warshaw. Roger Hodge is The Intercept’s Editor-in-Chief, and I’m Ryan Grim, D.C. Bureau Chief of The Intercept.

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