Interview: 3 reasons why medications are so expensive in the US | Kiah Williams

April 29, 2025·29 min·2 clips

Dr. Lalani describes his patient Jane, who couldn't afford the $400 copay for a $1,200-per-month endometriosis drug, missed too many days of work, and ultimately lost her job, her insurance, and her access to medication.

1. TED Health examines why US prescription drug prices are among the highest in the world, using insulin and Humira as primary examples. 2. The episode features a TED-Ed lesson narrated by Christina Greer and written by Kiah Williams, followed by an interview between host Dr. Shoshana Ungerleiter and Dr. Hussain Lalani, an instructor of medicine at Harvard Medical School and primary care physician at Brigham and Women's Hospital. 3. The episode's central question is why the US, with the most drug development and profit of any country, also has roughly one in four Americans reporting difficulty affording prescriptions. 4. Frederick Banting, who co-developed the first insulin therapy in 1921, transferred his patent to the University of Toronto for one dollar, declaring insulin belonged to the world; a century later, US patients pay an average of ten times more for insulin than patients in many other countries. 5. A vial of insulin costs less than six dollars to manufacture; three pharmaceutical companies have dominated the insulin market, and average insulin list prices tripled over two decades before the Inflation Reduction Act capped patient out-of-pocket costs at $35 per month in 2023. 6. The TED-Ed lesson identifies three main drivers: patent gaming that extends monopolies beyond original terms; the absence of a national drug negotiation program; and lack of transparency among supply chain intermediaries including pharmacy benefit managers (PBMs). 7. The drug Humira, used to treat autoimmune conditions including rheumatoid arthritis, had its price raised 27 times since 2003 and costs over $96,000 per year without insurance; its maker filed over 240 patents after the drug was already on market, with roughly 130 granted, generating $114 billion in additional revenue between 2016 and 2023 when the core patent would otherwise have expired. 8. In 2018, of every dollar spent on insulin, manufacturers received 46%, pharmacies 20%, PBMs 14%, wholesalers 8%, and insurance companies 10%; as insulin list prices rose between 2014 and 2018, the manufacturer's share decreased while the intermediary share grew. 9. Dr. Lalani traces his interest in prescription drugs to childhood Sundays sorting his grandmother's medications for blood pressure and lung disease into her pillbox, an experience that led him to observe 'the harms when people are unable to afford their medicines' throughout medical training. 10. Lalani describes his patient Jane, who had severe endometriosis, finally found an effective FDA-approved drug (elagolix/Oralissa, priced at $1,200 per month), but could not afford the $400 monthly copay with her employer insurance, stopped taking it, and ultimately lost her job, her insurance, and her medication access. 11. Lalani's conclusion from the Jane case: 'Prescription drugs do not work if the cost of the drug hurts more than the illness itself.' 12. Lalani identifies three primary structural drivers of high costs: patent gaming that limits competition, the absence of a national purchasing program that could use collective buying power for all 340 million Americans, and opacity in the money flows between pharmaceutical companies, wholesalers, pharmacies, PBMs, and insurers. 13. Brand name drugs represent about 10% of all prescriptions filled in the US but account for roughly 80% of total prescription drug spending; direct-to-consumer pharmacies such as Mark Cuban's Cost Plus Drug Company are effective for generic drugs but provide less benefit for brand name drugs. 14. Lalani and colleagues at the Program on Regulation, Therapeutics, and Law (PORTAL) at Brigham and Women's Hospital published a paper in JAMA titled 'Strategies to Help Patients Navigate High Prescription Drug Costs,' outlining seven strategies including copayment cards, patient assistance programs, and direct-to-consumer pharmacies. 15. Patients with private insurance struggling to afford a brand name drug can apply online in about two minutes for a copayment card; patients without private insurance must use different pathways such as public assistance programs, patient assistance programs, or generic alternatives. 16. AstraZeneca, Boehringer Ingelheim, and GSK have voluntarily capped out-of-pocket costs for asthma and COPD inhalers; Massachusetts passed a state law capping at least one diabetes, asthma, and heart disease medication at $25 per month. 17. A RAND Corporation study found US brand name drug prices are approximately four times higher than in other high-income countries; a PORTAL study found that more than half of the top 50 drugs sold by Medicare in 2020 were only marginally better than existing treatments for the same conditions. 18. The interview is conducted in a Q&A format with Dr. Ungerleider asking focused questions and Lalani providing clinical anecdotes alongside policy analysis; the tone is measured and evidence-based throughout. 19. People who have faced unexpected drug costs, caregivers managing complex medication regimens, and anyone interested in US healthcare policy will find the episode practical and specific. 20. Listeners seeking emotional narratives or international healthcare comparisons beyond brief data points may find the episode's policy-heavy second half more technical than they expected.

As heard by us

A clear, patient-centered explainer on why U.S. drug prices stay high, with insulin as the most concrete case study.

TED Health takes the sticker shock of a prescription refill and traces it through the machinery that keeps U.S. drug prices hard to understand.

Read the full review in PlayNext →

Why you'd press play

Why your insulin bill can stay high even when the medicine costs only a few dollars to make.

Read the full recommendation in PlayNext →

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from TED Health