Ethics of Rising Drug Costs


Rising insulin prices have recently gained national attention – insulin is needed by patients to survive, yet its prices have rapidly risen beyond unaffordable for many. These high prices comprise patients’ well-being, and have resulted in deaths when patients try to stretch their insulin supply.
            While insulin may be in the spotlight for now, it is far from being the only drug to have seen drastic price increases.  The dilemma of prescription prices has become an ethical issue that needs to be addressed on a national scale.  Many drug companies claim these high prices are necessary due to the costs of research and development. Nirmal Mulye, CEO of Nostrum Laboratories increased the price of nitrofurantoin to over $2,000 bottle, Nitrofurantoin, however, has been on the market for decades and Mulye doesn’t contribute the rise in price to R&D expenses. Mulye claims he was able to increase the price because Nostrum is one of two companies that sells a liquid form of the drug. He raised the price because he could, and patients have no choice but to pay. When asked about the change in price, Mulye stated ‘“I think it’s a moral requirement to make money when you can… to sell the product for the highest price”’ (Hiltzik, 2018, “Drug Executive: It’s a ‘moral requirement’ to charge patients the highest price”, LA Times). I think it’s safe to say most people (especially patients) would disagree with Mulye’s statement, and his idea of a “moral requirement”. Some companies have already taken stances in direct opposition to rising costs.
            Many insurance companies have recently capped insulin prices, and manufacturers like Sanofi and Eli Lilly initiated new savings programs with significantly improved prices (Sanofi’s deal is 10 boxes of pens for $100 each month). Other companies, like Walmart have also made deals with companies to have their own generic insulins at lower price.  It’s refreshing to see manufacturer’s and insurance companies holding themselves more accountable for patient care, but it’s something that should have happened decades ago. Denying patients access to a drug that they die without is highly unethical in any situation, let alone to increase profit margin. Sanofi, Eli Lilly, and other manufacturers have begun to hold themselves accountable for patient well-being, triggering reform in the industry, but another manufacturer has been leading this ethics battle for decades.
            In 1980s, Ivermectin manufacturer Merck realized that the drug could be used to treat onchocerciasis, also known as river blindness. The parasitic disease was endemic in Western Africa. Upon realizing that they possessed the treatment, Merck created the Mectizian Donation Program in partnership with the WHO, pledging to donate as much Ivermectin as needed for as long as was needed to countries in need. The program was expanded to include treatment of lymphatic filariasis (elephantiasis), another parasitic infection treated by Ivermectin. GSK partnered with Merck to donate albendazole for the treatment of elephantiasis. To date, Merck has donated over 2 billion treatments through the program. Several participating countries have been able to eliminate river blindness, with others well on their way to achieving the same goal.
            As ethics in pharmacy draws more attention, hopefully more manufactures, insurers, and pharmacies will take steps to ensure the welfare of their patients around the globe. Programs like Merck’s MDP have saved countless lives, and those companies have been successful, despite the cost of the drugs they have donated. R&D for new drugs will always be a costly expense in pharmacy, but Merck and others have proved that high drug costs aren’t necessary for company survival, and may be a sign of our own greed.



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