[ExI] Why is “cost of living” such a big problem?

Fri Nov 6 05:45:32 UTC 2026

If the prices in the USA actually went to drug development I wouldn't be
upset at all.
However much of your prices are pure predation and do not result in
anything other than wealth to persons and companies who do not contribute
at all to anything useful.

Again an summary since writing on my phone is bad, this is however
something I would be prepared to spend time on so l am sorry for using this
shortcut.
I am using the epipen prices as an example since mylans famous price hike
doesn't result in any gain what so ever for any sophont living in US. Mylan
did not develop adrenaline and bought everything from another company who
didn't develop shite either.
Only brilliant profits here.
/Henrik

## The EpiPen Price Scandal: A Case Study in Cronyism, Not Capitalism

When Mylan acquired the rights to the EpiPen in 2007, a two-pack cost about
$100. By 2016, it was over $600 — a 500% increase on a device that delivers
roughly a dollar's worth of epinephrine (Seven Pillars Institute, House
Oversight Committee). Here's the part that should bother every believer in
free markets: this wasn't the market working. It was the market being
*blocked* — by a company gaming Washington, a slow-moving FDA, and a cozy
relationship between Big Pharma and the political class.

### The price hikes

Mylan raised the list price steadily rather than in one shocking jump:
$103.50 in 2009, $264.50 by 2013, $461 in 2015, $608.61 by 2016 — while
holding roughly 90–95% of the market with no generic rival in sight (Seven
Pillars Institute). CEO Heather Bresch defended the increases before
Congress in September 2016, blaming "the complexity of the health-care
system" rather than the company's own conduct (USA Today, Drug Discovery &
Development).

Worth noting for the political angle: Bresch is the daughter of former West
Virginia governor and U.S. senator Joe Manchin ([Snopes](
https://www.snopes.com/fact-check/bresch-manchin-daughter/)). And her
mother, Gayle Manchin, as president of West Virginia's Board of Education,
spearheaded a campaign that pushed states to require schools to stock
EpiPens — helping build Mylan's near-monopoly in the school health sector,
an arrangement USA Today flagged as a clear conflict of interest
([Wikipedia](https://en.wikipedia.org/wiki/Gayle_Conelly_Manchin)). EpiPen
sales passed $1 billion for the first time in 2015 (Seven Pillars
Institute).

### The playbook: how Mylan kept prices up and competitors out

**1. Cheating Medicaid — on the taxpayer's dime.** Mylan classified EpiPen
as a *generic* drug in the Medicaid rebate program even though it marketed
and priced it as a brand-name product with no therapeutic equivalent.
Generic classification meant far lower rebates — so Mylan could hike prices
in the private market while shortchanging state Medicaid programs. The
company settled with the Justice Department in 2017 for **$465 million**;
HHS's own inspector general estimated taxpayers were shorted as much as
**$1.27 billion** (US DOJ, BioPharma Dive). The scheme was exposed by
Sanofi — a competitor that was *paying* the higher brand-name rebates on
its rival product (Healthcare Finance News).

**2. Pay-for-delay with Teva.** When Teva prepared to launch a generic
EpiPen, a 2012 patent settlement kept it off the market. Plaintiffs alleged
a quid pro quo: Teva delayed its EpiPen generic, and Mylan in return held
back its own generic of Teva's drug Nuvigil. That's not competition — it's
two companies agreeing consumers lose. Viatris (Mylan's successor) settled
the antitrust suit in 2022 for **$264 million**; Pfizer, which manufactured
the EpiPen, earlier paid **$345 million** to consumers and insurers (NBC
News, Fierce Pharma, Fierce Pharma).

**3. Buying off the middlemen.** Mylan allegedly used rebate and fee
arrangements with pharmacy benefit managers (PBMs) — the opaque gatekeepers
of the drug-pricing system — to keep competing auto-injectors off insurance
formularies, locking out products like Adrenaclick and Auvi-Q (Wellzrx,
BioPharma Dive). The PBM system itself, with its total lack of
transparency, is a big part of why price hikes don't get punished the way
they would in a real market (House Oversight Committee).

**4. EpiPen4Schools — "free" pens with strings attached.** Mylan offered
schools free or deeply discounted EpiPens, on the condition they agreed not
to purchase competitors' products for a period — effectively wiring EpiPen
into the entire public school submarket and training a generation of
parents to ask for it by name. The New York Attorney General and U.S.
senators opened investigations into the program's exclusivity terms in 2016
(US District Court, Kansas).

**5. Regulatory barriers doing the rest.** Auto-injectors are hard to copy
and slow to get through the FDA — a barrier the House Oversight Committee
itself acknowledged as a reason competitors stayed out (House Oversight
Committee). Sanofi's rival Auvi-Q was separately pulled from the market in
2015 over a device defect, leaving Mylan essentially alone (Chemanager).

### The bottom line

At the House hearing, Rep. Elijah Cummings put it bluntly: Mylan raised
prices "to get filthy rich at the expense of constituents" (Drug Discovery
& Development). After the outrage, Mylan rolled out its own "authorized
generic" at half price — a move critics saw less as price relief and more
as a way to protect margins ahead of real competitors (Healthcare Finance
News).

The conservative takeaway is straightforward: this is what happens when
competition is *prevented* — through Medicaid misclassification,
pay-for-delay deals, PBM backscratching, and exclusive school contracts —
rather than allowed to work. A device containing a dollar of medicine sold
for $600 not because of the free market, but because the free market was
never allowed to show up. When government programs can be gamed and
regulatory hurdles shield incumbents, the taxpayer and the patient pay the
bill (Wellzrx).

Den fre 6 nov. 2026 03:32Keith Henson via extropy-chat <
extropy-chat at lists.extropy.org> skrev:

> On Thu, Nov 5, 2026 at 6:18 PM spike jones via extropy-chat <
> extropy-chat at lists.extropy.org> wrote:
>
>>
>>
>> > *On Behalf Of *Adrian Tymes via extropy-chat
>> *Subject:* Re: [ExI] Why is “cost of living” such a big problem?
>>
>>
>>
>> On Thu, Nov 5, 2026, 5:41 PM <spike at rainier66.com> wrote:
>>
>> >…Medicine does cost a lot more in the USA, for reasons we already
>> established…
>>
>> >…Sweden's IP laws are comparable to the USA's.  This is not the primary
>> reason for higher drug prices in the USA…. Adrian
>>
>>
>>
>> Good then we should just use low priced medications developed in Sweden
>> and not buy them from us.
>>
>>
>>
> We are already buying a lot of designed in the US medications from China
> or the precursors.
>
> But within a few years we will be buying designed in China drugs because
> their Pharma is growing larger than the US.
>
> I could say a lot about Indian drugs, but for it to make sense I would
> have to talk about stuff I don't often mention.
>
> Keith
>
>> spike
>>
>>
>> _______________________________________________
>> extropy-chat mailing list
>> extropy-chat at lists.extropy.org
>> http://lists.extropy.org/mailman/listinfo.cgi/extropy-chat
>>
>
>
> --
> Best wishes,
>
> Keith
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