Americans are deeply concerned about the cost of prescription drugs—and for good reason. Over the last decade, drug prices have outpaced inflation, and Americans are paying more than two and a half times what other wealthy nations pay for the same drugs.
Most people believe high prices are simply the result of expensive research and development, which may hold for some cutting-edge therapies. But it’s also the case that pharmaceutical companies, insurance industry, and their middlemen, often exploit complex regulations to jack up the cost of their products.
For example, epinephrine is a decades-old, life-saving drug used to treat severe allergic reactions. It is not new, rare, or especially expensive to produce, costing roughly $10 per milligram. Yet patients routinely pay hundreds of dollars for a single epinephrine auto-injector. Why?
Part of the answer lies in regulatory barriers that limit how the drug can be provided. In Texas, as in many places, epinephrine for emergency use is effectively restricted to delivery through auto-injectors rather than more affordable pre-filled syringes prepared by physicians or independent pharmacists. This stands in stark contrast to other injectable medications like insulin or testosterone, which patients commonly and safely administer using standard syringes at a fraction of thecost.
This regulatory structure creates a protected market for branded auto-injector products, allowing pharmaceutical and insurance companies—and thepharmacy benefit managers (PBMs) who sit in themiddle of the supply chain—to drive up prices. In a competitive market, lower-cost alternatives would put downward pressure on pricing. Instead, patients are left with few options in life-or-death situations, making them especially vulnerable to price gouging.
Inhaled steroids for asthma and COPD are equally overpriced. Something that should be $25 is usually $200 to $350.The result is a system where middlemen and manufacturers profit handsomely from artificial constraints, not innovation.
Texas lawmakers should revisit these rules and allow physicians and independent pharmacists to dispense pre-filled epinephrine syringes directly to patients. Doing so would introduce competition, lower costs, and most importantly, ensure that no one has to choose between affordability and survival.
