Opinion | Hold right industry accountable for unaffordable health care: Big Pharma

In 1923, Frederick Banting, Charles Best and James Collip discovered insulin, a drug that would go on to save millions of individuals with diabetes. They sold the patent to the University of Toronto for $1. One dollar. Because they believed a lifesaving drug belonged to the people who needed it, not to whoever could extract the most from them.

Dr. Adam C. Hunt is a practicing emergency medicine physician. Dr. Emily Hurst is an intensivist. (Courtesy photos)

In 1955, Jonas Salk developed the polio vaccine and refused to patent it at all. When asked who owned it, he replied: “There is no patent. Could you patent the sun?” His goal was singular: the fastest, widest distribution possible.

As physicians, we believe that ethos did not fail medicine. In fact, it defined its greatest era.

What has changed since then is not the complexity of modern drug development, though manufacturers will tell you that’s the story. What changed is the calculation. When the potential return on a drug patent became a financial instrument, and when Wall Street began pricing pharmaceutical futures, the patient became secondary to the shareholder. Every decision, from list price to who gets access, started running through a different filter: not “what does this patient need,” but “what does this protect for the people who hold our stock.”

Physicians, nurses, and hospitals don’t answer to shareholders. We answer to the patient in front of them. Every prescription written, every treatment plan built, every dollar a safety-net clinic spends is made against one standard: what is best for this patient, above all else. That is the ethos under which health care providers still operate, even as the industry supplying their medicine has organized itself around a different one entirely.

And yet there’s a sleight of hand happening in the American health care debate right now, and it’s worth naming. Patients are being fed a story that the hospitals treating them, the physicians prescribing to them, and the clinics serving their communities are the problem; that providers are gaming the system, and that they are the reason healthcare costs so much. It’s a compelling story. It’s also a convenient one for an industry trying to redirect attention away from the prices it sets in the first place.

Consider the 340B program, one of the clearest examples of this shift in calculation playing out in real time. Congress created 340B in 1992 after manufacturers eliminated the voluntary discounts they had long extended to safety-net hospitals and clinics, the moment a new federal pricing rule made those discounts cost something. Hospitals reported drug cost increases averaging 32%. For providers already operating on thin margins while caring for the most vulnerable, that wasn’t a budget line item. It was an existential threat.

The 340B program restored access that had already existed, requiring manufacturers, as a condition of participating in Medicaid and Medicare Part B, to offer discounted drug prices to qualifying safety-net providers. The intent was explicit: stretch scarce federal resources as far as possible so that the providers caring for underserved communities could keep their doors open and keep their patients alive.

This was a correction. The program restored access that had already existed, and that manufacturers had eliminated the moment it cost them something.

Now, three decades later, manufacturers are fighting to dismantle the very program their own pricing decisions made necessary. Since 2020, several major drug companies began unilaterally restricting 340B discounts for contract pharmacies, the very mechanism that allowed small clinics without in-house pharmacies to access the program at all. When the federal government pushed back, manufacturers sued.

Thankfully, here in Michigan, our elected officials are working to put patient needs before drug companies with Senate Bills 94 and 95, which would help protect the 340B program at the state level. The legislation safeguards critical cost savings that hospitals reinvest in patient care and community health. The passage of these bills would help protect physicians, like us, and safety-net hospitals participating in 340B so that we can leverage this program, built specifically for us, to keep treating patients who can’t afford the prices the manufacturers themselves set.

If we want an honest conversation about health care affordability, it starts with an honest accounting of who sets these prices, who fights every safeguard designed to moderate them, and who ultimately pays when those safeguards fall. The answer to all three is the same.

Stop vilifying the care providers saving lives every day. Hold the right industry accountable for making healthcare unaffordable: Big Pharma.