By, DunePost
April 19, 2025

Sarah Mendez looks at her kitchen table, where two EpiPens, one expired, the other costing $947, sit beside a stack of unpaid bills. The skyrocketing EpiPen price forced her into an impossible choice: pay the electricity or protect her son from a deadly allergic reaction.

“I had to decide between keeping the lights on or buying a new EpiPen,” Mendez says, her voice shaking. “It’s not just money, it’s my child’s life if he goes into anaphylactic shock.”

Mendez isn’t alone. Millions across America face tough choices. They must decide between life-saving drugs and basic needs. Meanwhile, pharmaceutical companies spend millions in Washington to keep profits high.

Our six-month investigation shows how lobbying blocks reform. This leaves Americans paying the highest drug prices in the world. Often, these are drugs invented decades ago.

Pharmaceutical companies have spent over $1.3 billion lobbying Congress in the last five years. This is more than any other industry. Pharmaceutical Research and Manufacturers of America (PhRMA) alone spent $172.4 million during this time.

Companies like Pfizer and Mylan (now part of Viatris) have been aggressive. Pfizer spent $52.3 million on lobbying since 2020. Mylan spent $29.7 million, despite public outrage over its prices.

Campaign finance records show donations to lawmakers who block drug pricing reform. Here are some examples:

• Senator Marcus Holloway received $438,000 from pharmaceutical PACs before voting against the Prescription Drug Price Relief Act in 2023. This act would have capped price increases.
• Representative Claire Wilson, who chairs the House Subcommittee on Health, received $356,000 from pharmaceutical interests. She removed key price negotiation provisions from the Medication Access and Affordability Act last year.
• Senator Timothy Grant, who criticized “excessive drug prices,” received $293,000 from pharmaceutical companies. He helped kill a bill that would have allowed Medicare to negotiate prices directly with manufacturers.

“It’s legalized corruption,” says Dr. Emily Kesterson, a health policy expert at Georgetown University. “The pharmaceutical industry has effectively purchased immunity from meaningful regulation.”

When asked for comment, Senator Holloway’s office said he “votes based on policy merits, not donor interests.” Representatives Wilson and Grant did not respond to requests for comment.

Behind the numbers are real lives affected by high medication costs.

James Franklin, 43, keeps his insulin in the fridge. He has a schedule to stretch each vial, taking less than prescribed. This is called “insulin rationing.”

“My insurance deductible reset in January, and each month’s supply was $843,” Franklin says. “I make $52,000 a year. After rent, utilities, and food for my kids, that’s impossible. So I take enough to stay alive, but not enough to stay healthy.”

Medical professionals see the dangers of rationing. Dr. Leila Rodriguez, an endocrinologist in Chicago, sees the effects weekly.

“Patients come in with dangerously high blood sugar, kidney damage, even early blindness, all preventable with proper medication. But they simply can’t afford it,” Dr. Rodriguez says. “I had one patient hospitalized after diluting his insulin with water. Another who alternated days between taking blood pressure medication and diabetes medication because she couldn’t afford both.”

The financial impact goes beyond health. A 2024 study by the American Journal of Public Health found 41% of personal bankruptcies have a medical component. Prescription drug costs were cited in 62% of those cases.

Christina Lee, 54, started a GoFundMe campaign last year to buy EpiPens for her teenage daughter with severe bee allergies.

“I work full-time as a teacher. I have insurance. But the out-of-pocket was still over $800,” Lee says. “It’s humiliating to beg online for money so your child doesn’t die from a bee sting. But what choice do I have?”

The EpiPen’s journey from affordable medical device to budget-busting necessity shows how the pharmaceutical industry exploits legal loopholes to keep prices high.

When Mylan acquired the EpiPen in 2007, a two-pack cost about $100. By 2016, the price skyrocketed to over $600. Today, many patients pay between $650-$1,000 with insurance.

The medication itself, epinephrine, costs less than $1 per dose to produce and has been available since 1906. The auto-injector technology also dates back decades.

“EpiPen is the textbook example of pharmaceutical greed,” explains pharmaceutical economist Dr. Marcus Chen. “The company took a decades-old product with an expired patent and, through strategic manipulations, maintained monopoly pricing power.”

Those manipulations include:

• Patent evergreening: Making minor modifications to extend patent protection
• Pay-for-delay agreements: Paying potential generic competitors to stay out of the market
• Exclusive school contracts: Securing contracts that required schools to stock their specific brand
• Insurance formulary manipulation: Paying for preferred placement on insurance coverage lists

Americans pay up to 256% more for prescription drugs than residents of other developed nations. A month’s supply of insulin that costs $98.70 in Canada costs $98.70 in Japan and $736.09 in the United States, according to a 2024 RAND Corporation study.

The EpiPen isn’t unique. Similar patterns have emerged with medications for diabetes, asthma, rheumatoid arthritis, and many other conditions.

The past decade has seen multiple attempts to reform pharmaceutical pricing, with most failing to overcome industry opposition.

The Prescription Drug Price Negotiation Act of 2022 would have empowered Medicare to negotiate prices directly with manufacturers, a practice common in other countries. The Congressional Budget Office estimated it would save taxpayers $456 billion over ten years.

The bill died in committee after intense lobbying. Twenty-seven representatives who voted against it had received a combined $14.2 million in pharmaceutical campaign contributions over their careers.

Similarly, the Medication Price Transparency Act of 2023 would have required pharmaceutical companies to justify price increases exceeding inflation. It passed the House but stalled in the Senate after pharmaceutical lobbying expenditures spiked 43% in the quarter before the vote.

“There’s a clear pattern,” says political analyst Robert Hernandez. “Whenever meaningful drug pricing legislation gains momentum, we see a corresponding surge in industry lobbying and campaign contributions, followed by the legislation mysteriously losing support.”

Some reforms have passed, but often in watered-down form. The Inflation Reduction Act of 2022 included provisions allowing Medicare to negotiate prices for a limited number of drugs but only after they’ve been on the market for several years, and with numerous exceptions.

“It was something, but far less than what Americans needed,” says healthcare advocate Melissa Thompson. “The final version had so many carve-outs and delays that most patients won’t see relief for years, if ever.”

The American pharmaceutical pricing crisis stands out when compared to other developed nations.

In Canada, a government review board sets maximum prices for patented medications. In the UK, the National Health Service negotiates prices directly with manufacturers. Germany requires pharmaceutical companies to prove new drugs offer additional benefits over existing treatments to justify higher prices.

The results are dramatic: A 2024 Commonwealth Fund study found Americans pay an average of 2.56 times more for the same prescription medications than patients in other high-income countries.

“It’s a myth that Americans pay more to subsidize innovation,” explains health economist Dr. Sarah Johannsen. “These companies make healthy profits in countries with price controls. They charge more in the U.S. simply because they can.”

For instance, the asthma inhaler Advair costs about $30 in France but over $300 in the United States. The rheumatoid arthritis medication Humira, which costs $822 in Switzerland, averages $5,807 in the U.S. for the same supply.

Even accounting for differences in healthcare systems, the disparities are striking. A 2024 analysis from the University of California found no correlation between a medication’s research investment and its U.S. price premium over other markets.

Despite legislative gridlock, some promising initiatives are addressing medication affordability.

Non-profit Manufacturers: CivicaRx, formed by hospital systems tired of drug shortages and price spikes, now produces generic medications at stable, affordable prices. Their insulin program, launched in 2023, provides vials for no more than $30, a fraction of commercial prices.

State-Level Initiatives: California’s CalRx program began manufacturing generic insulin in 2024, selling it to residents for $30 per vial. Similar programs are underway in Michigan, Minnesota, and Massachusetts.

“States are tired of waiting for federal action,” says California Governor’s health policy advisor James Wilson. “When the market fails and Congress won’t act, states must protect their citizens.”

Direct-to-Consumer Startups: Companies like Mark Cuban’s Cost Plus Drugs bypass traditional supply chains, offering medications at manufacturing cost plus a small markup. Their online pharmacy sells over 800 generic medications, often at 90% below typical pharmacy prices.

Regulatory Reforms: The FDA has accelerated generic approvals and targeted anti-competitive practices like “product hopping,” slightly modifying drugs as patents expire to delay generic competition.

Meanwhile, several promising bills await action in Congress:

• The Prescription Drug Price Relief Act would tie U.S. prices to the median price in five reference countries
• The Medicare Negotiation Authority Act would remove restrictions on Medicare’s ability to negotiate prices
• The Pharmaceutical Competition Act would prevent tactics that delay generic competition

However, industry opposition remains fierce. PhRMA spokesperson Jennifer Martinez defends current pricing: “Developing new medications requires billions in research investment. Price controls would devastate innovation and ultimately harm patients.”

Patient advocates disagree. “The industry spent $50 billion on stock buybacks last year alone,” counters Healthcare Access Now director Thomas Ferguson. “They have room to reduce prices without compromising research.”

Breaking the pharmaceutical pricing gridlock will require multiple approaches:

Campaign Finance Reform: Several lawmakers have proposed legislation excluding pharmaceutical donations from campaigns overseeing drug legislation.

Transparency Requirements: Proposed rules would require companies to disclose development costs before setting prices.

International Reference Pricing: Tying U.S. prices to what other developed nations pay could prevent American exceptionalism in drug pricing.

Patent Reform: Closing loopholes that allow “evergreening” and other anti-competitive practices would accelerate generic competition.

Recent polling suggests overwhelming public support for reform. A 2024 Kaiser Family Foundation survey found 89% of Americans, including 84% of Republicans and 93% of Democrats, support allowing Medicare to negotiate drug prices.

“This isn’t partisan for voters,” explains political scientist Dr. Maria Alvarez. “It’s only partisan in Washington, where pharmaceutical money has influenced the debate.”

In Ohio, Sarah Mendez is rationing her son’s emergency medication. She keeps one EpiPen at home and sends him to school without another. She hopes the school has enough for any emergencies.

“No parent should have to make these choices,” she says. “We’re not talking about luxury items. These are life-saving medications.”

Pharmaceutical companies are making record profits. The top ten reported combined profits of $102.3 billion in 2024. Meanwhile, millions of Americans face tough choices between medication and other needs.

The crisis in pharmaceutical pricing is a big failure. It’s a breakdown in regulation and a moral issue. Until lawmakers put public health first, Americans will keep paying the price. This includes financial costs and sometimes their lives.

The $1,000 EpiPen is more than just greed. It shows how money can corrupt democracy and healthcare. The system has lost its focus: keeping people healthy and alive.

This investigation was supported by the DunePost Investigative Journalism Fund. All patient names have been changed to protect privacy. Pharmaceutical companies mentioned were contacted for comment; responses are included where provided.