Three pharma giants control 90% of insulin.
A century-old drug costing $2 to make but selling for $300+ in America ($6 in Canada).
8.4 million Americans need it to survive. 1 in 4 ration doses and risk death.
The FTC has proof it's all coordinated.
Here's the $22B conspiracy 🧵
Jesse Lutgen, 32, Iowa. Dead 2018.
Rationed insulin because $1,000/month was impossible.
Jeremy Crawford, 39, Texas. Dead 2019.
Tried cheaper alternatives that failed.
Alec Smith, 26, Minnesota. Dead 2017.
These aren't rare tragedies.
They're business casualties.
The math is grotesque: 8.4 million Americans need insulin to live.
1 in 4 ration doses to afford rent.
That's 2+ million people playing Russian roulette with their pancreas monthly.
Rationing triples your risk of death.
The companies know this. They profit anyway.
Here's the scam: A vial cost $21 in 1999.
Same insulin, same factory, same formula.
Today? $300+.
Production costs haven't changed - still $2-5 per vial.
The other $295 is pure greed, dressed up as "innovation."
There is no innovation. Just patent games.
Patent evergreening is their weapon.
Insulin was discovered in 1923, sold for $1 to save lives.
Big Pharma adds a new pen design, tweaks the formula slightly, files 70+ new patents.
Boom - 20 more years of monopoly. Generics blocked. Competition crushed.
The Big Three don't compete - they coordinate.
From 2007-2016, they raised prices in perfect lockstep.
Sometimes on the same day.
Humalog: $74→$269.
Novolog: $55→$289.
Lantus: $88→$269.
This isn't market forces. It's cartel behavior in white coats.
But here's the dirty secret nobody talks about: The high prices are intentional.
Pharmacy Benefit Managers (PBMs) demand massive rebates - up to 70% of list price.
To pay bigger rebates, companies jack up sticker prices.
Patients pay the inflated amount. PBMs pocket the difference.
It's a kickback scheme disguised as healthcare.
Manufacturer inflates price to $300. Pays $200 rebate to PBM.
PBM keeps $50, gives insurer $150 "discount."
Patient still pays $300 copay based on list price.
Everyone profits except the diabetic who needs insulin to breathe.
The global price comparison is criminal:
Same insulin vial costs $6 in Canada, $2 in South Africa, $1 if you're Doctors Without Borders.
But $300+ in America.
Same factories. Same drug. Only difference?
Americans are held hostage by a legal extortion racket.
Even with recent "reforms," it's theater.
Medicare's $35 cap helps seniors. Companies' voluntary caps are PR stunts that can vanish tomorrow.
71% of rationers are under 65 - still paying full freight.
The machine keeps churning, bodies keep dropping.
The FTC is finally fighting back.
April 2025: Lawsuit against PBMs for "perverse incentives."
Massachusetts AG suing all three companies plus PBMs for artificial price inflation.
400+ cases in federal court. The evidence is overwhelming: This is organized theft.
Eli Lilly made $34 billion in 2024 revenue.
Novo Nordisk posts record profits while patients die.
Sanofi executives get bonuses while families deliver ashes to their headquarters.
This isn't capitalism - it's murder with a profit margin.
The fix is simple:
Break the patents. Ban the rebate games. Universal $35 caps. Import from Canada.
But Congress won't act because Big Pharma owns them.
$374 million in lobbying buys a lot of senators.
Dead diabetics don't vote or donate.
I’m Shawn, a Generative AI Consultant passionate about building AI-driven solutions.
I write about AI, startups, and the future of work.
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