Original subtitles

-[theme music playing] -[crowd chanting]

[siren wailing]

[audience cheering]

Hello!

Oh, my God. Thank you so much.

Thank you!

Thank you. Wow!

Thank you so much.

I'm Hasan Minhaj. Welcome to Patriot Act.

Thank you so much for coming.

All right, I have a secret. Okay?

Tonight, I promise...

I'm not gonna beef with any foreign government. Okay?

Instead, I want to talk about something that's killing people in my own country.

Drug pricing.

In America, prescription drug prices are skyrocketing,

and politicians on both sides of the aisle have made drug pricing an urgent priority.

America pays�the highest�drug prices in the world,

and it's not impossible to fix.

People are sick and tired�of the greed of the pharmaceutical industry.

One of my greatest priorities...

is to reduce the price of prescription drugs.

Why did he say that like he was opening up Jurassic Park?

"Welcome to...

prescription drugs."

A velociraptor comes out, but it's made of Fentanyl.

Drug pricing has been a problem for decades,

but it's only getting worse, and this year is no exception.

[man] More than three dozen drug companies have already hiked prices in the new year.

[woman] The average hike is 6.3%,

nearly three times the rate of inflation.

This is terrifying, especially when you consider that

nearly half of the country takes prescription drugs.

We're talking about millions of Americans, or as they call themselves, Brockhampton.

There are too many people in Brockhampton, and I know this...

because I'm in Brockhampton.

Hey, don't laugh, you're in Brockhampton too, okay?

I saw you at the meeting.

Yeah, you're the audio guy.

Probably the most egregious case of drug price gouging was back in 2015.

We all remember Martin Shkreli,

the man who looks like a child's drawing of Keanu Reeves.

One tablet of Daraprim�used to cost $13.50.

The drug maker recently increased the price to $750.

Why was it necessary to increase the price of Daraprim so drastically?

Well, it depends on how you define "so drastically,"

because the drug was unprofitable at the former price.

So any company selling it would be losing money.

Martin Shkreli became the most hated man in America

after raising the price of his company's life-saving drug over 5,000%,

and people got pissed.

The only way it could have been worse is if he teamed up with Ja Rule,

which would be the only festival

where people wouldn't be able to get drugs.

Now, look. Shkreli didn't just fuck with sick people.

He also fucked with the Wu-Tang Clan, who as you all know,

ain't nothing to fuck with.

Shkreli bought the only copy�of the Wu-Tang Clan album for $2 million.

You guys heard about this album, right? The $2 million Wu-Tang album?

And then he didn't let anyone listen to it,

and it turned into�one of the most bizarre beefs in history.

The feud continues to escalate between former Turing Pharmaceutical CEO

and Ghostface Killah, just releasing this video response.

Watch this.

I don't even know how it came to this, like this is Ghost versus Peter Pan

in, like, 2016.

You know what I mean? All you can do right now

is just try to fly away in front of my face, man. You know what I mean?

Did you see that Peter Pan wipe?

Shkreli pissed off Ghostface Killah so much,

he learned aftereffects.

You think after all of this shitbaggery, Shkreli might have some regrets.

If you could rewind the clock a few months,

I wonder if you would do anything differently.

I probably would have raised the price higher

is was probably what I would have done.

Your one regret was not raising the price higher?

That's like if Ben Affleck's biggest regret

was not getting enough stupid tattoos.

Have you seen his back? It's just a Windows 95 screensaver

of bad decisions.

It's the fucking worst.

By the way, Shkreli jacking up the price of Daraprim by 5,000%,

it was 100% legal, even though it feels like it shouldn't be.

It's like when they sell you a Planet Fitness membership.

How is that legal?

They're like, "Look, we've got three dumbbells,

half a shower, and you can never leave,

now go get the body of your dreams in this house of nightmares."

Big pharmaceutical companies don't pull a Shkreli, all right?

They don't raise prices 5,000% at a time like maniacs.

At the beginning of last year, drug companies increased

almost all their prices between one and 10%.

Drug makers raise prices the same way Chuck Schumer's glasses

are falling off his head.

It's so slow, you might not notice.

Why are his glasses always at fourth and goal?

Like, they're just about to dive into the end zone.

But those small increases add up.

If you have a major health problem,

chances are it now costs you a lot�more to stay alive.

Maybe the best example of how crazy drug pricing has become is insulin,

a drug that millions of people with diabetes need to survive.

In 1996, one common type of insulin cost $21.

Now that exact same insulin costs $295.

Supreme is watching this right now, and they're like, "Damn.

We should make insulin."

Insulin is one of the most expensive liquids in America.

A gallon of the cheapest insulin is up there with LSD,

Chanel No. 5 and cobra venom,

which when combined with a heat source actually create Rudy Giuliani.

In the US alone,

seven million diabetics need insulin injections just to survive.

23 million more people are also diabetic, including Ghostface Killah.

Seriously, he's diabetic.

Add that together with people who are pre-diabetic

and it comes to 100 million people.

That's almost a third of America. Now, buckle up,

'cause I'm about to become�Indian Miss Frizzle

and Magic School Bus you into the pancreas.

There are two main types of diabetes, okay?

Type 1 diabetes occurs�when your pancreas doesn't naturally create insulin.

Yes, that is your pancreas or as it's also known as your indoor dick.

-In this case... -[audience laughing]

Look, you don't understand, you better laugh at that.

There is a graphics guy that worked on this shit for 12 hours.

The renderings...

"Is it phallic enough?"

We made him re-render.

Yeah, that's all he got.

This dude did Oculus Rift for a penis, and you guys are doing-- all right.

In this case, insulin must be acquired from another source.

Think of type 1 diabetes like Melania Trump at the RNC.

She couldn't produce her own speech, so she had to obtain a speech

from another source.

How did that get a bigger reaction,

than the indoor dick?

Type 2 diabetes occurs when your body doesn't use the insulin

produced by the pancreas correctly.

This form of diabetes can occur later in life due to age, genetics,

lack of exercise or Paula Deen.

Before I cut this bad boy up though,

I think I need to run him through a little powdered sugar. Whoa!

Little bit more powdered sugar, a little fresh cream, a little vegetable.

Look at that yummy fried cheesecake.

Mmm! Mmm!

Okay, that looks like a fried cheesecake,

but this is actually a Paula Deen salad.

Now, look.

Look, there's no real reason to bring up Paula Deen,

but around the time this clip aired,

she had a big secret.

Why did you take so long to let people know

-that you had type 2 diabetes? -I intentionally did it, Al.

I could have walked out and said,

"Hey, y'all, I've been diagnosed with type 2 diabetes and walked away.

I had nothing to give

to my fellow friends out there.

The most surprising part of this clip

is that she calls him Al and not the "N" word.

Untreated diabetes can have serious consequences

like nerve damage, kidney failure, even death,

and as insulin prices continue to spike,

diabetics are taking drastic measures to get their hands on the drug.

A growing number of diabetics and their families

are now facing some tough choices when it comes to paying for the drug.

Some are turning to�the black market to buy illegal insulin.

-[man] So, 200 for two boxes, -Yeah.

and then the extra-- Okay, cool.

[man 2] Producer John Dias easily found insulin for sale online,

posted by people like this New Jersey woman

who told him as a diabetic herself, she has extra to sell.

Wait, where are they meeting?

It looks like they just met at her house and then she was like,

"Look, I don't want to blow up my spot. Let's just cross the street."

Insulin black markets aren't even the worst of it all.

Desperate patients have also started taking lower doses

to make their insulin supply�last longer,

and that is incredibly dangerous.

[man] Alec Smith died last year

because he couldn't afford insulin medication

that could have kept him alive.

Can you even imagine what it was like to tell people that your son died at 26

because he struggled to afford the one medicine they created

to save his life?

Alec Smith lost his life because he was rationing insulin.

This isn't happening in other countries because insulin is way more affordable

pretty much everywhere besides America.

This insulin pen we bought in the United States cost us $140.

It would last us about a week.

This is an insulin pen that we bought in Taiwan.

It cost us $8.

Here's one that we bought in Canada for $13.

It's not just Taiwan and Canada. Greece, Israel and Germany

are all way cheaper than the United States.

Even when you add them up, they're nowhere even close.

I'm sorry, but insulin should not be cheaper in Germany.

Germans live on chocolate, beer

and the lie that their grandparents were good people.

By the way,

the high cost of insulin�is hitting people with insurance.

If you don't have insurance, you are truly screwed.

So why has insulin become expensive in the United States?

A big part of the reason�comes down to drug patents.

Three companies own�the majority of insulin patents.

Eli Lilly, Novo Nordisk and Sanofi Aventis.

No, those aren't designers who got banned from Fashion Week

for saying something racist in Italian.

These three companies account for�more than 90% of the global insulin market,

and one of them owned 100% of Paula Deen.

And we should mention you're a paid spokesperson for Novo Nordisk.

Absolutely, I have been compensated, just as you are...

for your work. Yes.

Yeah, it's not the same thing, Paula Deen.

Al Roker's not getting paid by Big Weather.

Also, people aren't dying because they can't get their hands

on bootleg versions of The Today Show.

"Hey, man. I've got Hurricane Gustav

from September 2008. You want it? Yeah.

Let's just cross the street first.

Give me that Today Show."

Companies with drug patents generally say they need to keep drug prices high

so they can recoup the cost it takes to develop a new drug,

but that wasn't the case with insulin.

Insulin wasn't discovered by pharma companies.

It was developed in 1921 by a team of Canadian researchers

that included Frederick Banting and Charles Best,

who realized how important insulin would be for the world,

and they sold the insulin patent to the University of Toronto

for just a dollar each, and those were Canadian dollars,

which are basically Post-it notes with the words "great job" on them.

Banting and Best�weren't trying to cash out.

They gave their discovery away because they wanted to help

as many people as possible.

The only problem is that it's difficult to make insulin

because it involves living cells in our body.

So the University of Toronto

licensed the manufacturing of insulin to, that's right,

Eli Lilly and Novo Nordisk,

and they�could patent any improvements,

and that's exactly�where the trouble started.

Quick time-out. Canada,

why would you ever�trust Americans with important discoveries?

Bieber, Drake, Arcade Fire, insulin, we always take all your best stuff

and ruin it. Unlike in other countries, US law says patents can be�extended

as long as you make changes to the drugs. I said changes not improvements.

You just have to prove it's not worse.

Think of it like SNL. It doesn't necessarily need to improve every year,

as much as it needs to find bizarre new uses for Alec Baldwin.

Drug companies are doing this strategy all the time. Between 2005 and 2015,

almost 80% of new patents�were for existing drugs.

These are changes to existing drugs�just to extend the patents,

and that's what insulin manufacturers do. They slightly tweak insulin.

They refile the patents, and then they lock out any competition.

Our government doesn't cap drug prices.

So these three companies have complete control over the cost of insulin.

They're basically an insulin cartel, except it's all legal.

The feds probably wouldn't have�fucked with El Chapo

if he just called cocaine "Elchapitor."

This is seriously like Narcos' insulin.

[woman] The prices of two prime insulin drugs rose in lockstep,

mirroring each other 12 times between 2008 and 2014.

If you raise your price and I raise my price to the same level,

what am I saying to you as a company?

Let's keep going.

Yeah, let's keep going. They're all in on it together,

the same way NBA players are all friends with each other.

Everyone's like, "Who's going to the Lakers next year?"

Just check LeBron's DMs.

Here's two more�competing brands of insulin

from Eli Lilly and Novo Nordisk.

These lines move in such perfect lockstep,

they look like they're about to invade Poland. Again...

I'm not saying they're price-fixing, because look,

these companies are very litigious, and I could get sued, all right?

[laughing]

So I'm just asking a question.

Are they price-fixing? And then...

I'm answering a question.�Yes, but, but...

that's not how the drug companies see it.

[woman] The companies deny they've broken any laws.

Sanofi told us, "There's strong competition on price."

Eli Lilly said, "It's aggressively competing on net

or negotiated price," and Novo Nordisk's president said

on the company's website that "increasing list prices

is designed to offset rebates and price concessions

to maintain profitability."

These are multi-billion-dollar companies, price-gouging people

who need their insulin to stay alive.

Drug companies do admit drug pricing has gotten out of control.

They just don't think�they're part of the problem.

They love blaming Pharmacy Benefit Managers or PBMs.

You know how, like, when you go to CVS for your prescription

and they're like, "Sit there by the blood pressure machine,

and Glen will be with you."

And then after, like,�45 minutes, you're like,

"Hey, can I just speak to someone?" And they're just like,

"Sit over there by the lube and stop talking!"

And you're like, "Fine."

And then when they finally ring you up, they tell you how much the drug cost

and how much your insurance covered. PBMs negotiated that price.

You've probably heard of the Big Three, Express Scripts,

OptumRx and CVS Caremark.

They're owned by or have merged with large insurance companies.

PBMs take a lot of heat from drug companies

and politicians for being nothing more than middlemen.

Our profit from that insulin has actually declined

over the last five to six to seven, eight years

[man] Hobbs attributes this to rebates Novo Nordisk pays

to middlemen like pharmacy benefits managers.

The middlemen became very, very rich.

Whoever those middlemen were, a lot of people never even figured it out,

they're rich.

You can tell he is excited about another new group to hate.

He's like,

"What color are those middlemen?"

But PBMs...

don't see themselves�as middlemen at all.

Here's a video by Express Scripts explaining what they think they do.

[woman] What is a pharmacy benefit manager?

Some people think we make pills. We don't.

Some people think we're an insurance company. We aren't.

Some people think we're middlemen, but we're not.

Without a PBM, patients and plan sponsors,

like businesses,�industry, schools and government

wouldn't have anyone in their corner negotiating with drug manufacturers,

so no one pays more than they need to.

Some people think we're middlemen. We're not.

Some people think we're parasites. We're not.

And some people think we killed JonBenet. Who knows!

It's hard to know what the most broken part of this system is,

but PBMs are a pretty good place to start.

[woman] Howard Jacobson, a pharmacist in Long Island, New York, for 40 years,

showed us a recent transaction for the diabetes drug Metformin.

He says if the patient paid out of pocket,

he would have sold it to them for $4,

but the patient used an insurance plan,

and there was a middleman, the PBM.

It told Jacobson to charge a $10.84 copay,

and it took�$8.91 for itself.

PBMs are a clusterfuck of rebates and negotiated payments.

See how confusing this chart is?

This is how the American Diabetes Association

tried to clarify what PBMs do.

How does this clarify anything?

It's so confusing.

It looks like a subway map.

This is how health policy expert Dr. Gerard Anderson

tried to explain drug pricing to the Senate.

Drug pricing is exceedingly complex.

Other experts in this panel have discussed the relationships between

the drug companies, the PBMs, the wholesalers and the pharmacies.

It's important to recognize, however, that the process begins

with the drug company setting the price.

I wore my tie�with the inverse writing of Leonardo da�Vinci.

I'm not even sure Leonardo da Vinci could understand drug pricing today.

By the way,

Professor Anderson really loves using that tie

to explain drug pricing.

Today, the tie and most of you can't see it,

is Leonardo da Vinci's writing.

I try to wear a tie that's related to my testimony.

Today, it's Leonardo da Vinci's left-handed backward writing in Latin.

You know drug pricing is complicated when professors are giving up on language,

and they're like, "Look, the only way people will understand this

is through tie-based metaphors."

But that's where we are.

Our drug pricing system is so broken,

everyone is just constantly passing the buck.

PBMs substitute expensive drugs and overcharge Medicare Part D.

They're lining their pockets with the money from the taxpayers.

Oh, so it's the PBMs.

Pharma companies determine their prices.

You need to have a pharma company CEO explain why they keep raising the prices.

Oh, it's pharma.

How much you pay is largely a function of how your insurance policy is set up.

Wait, it's insurance?

PBMs certainly play a problem here.

The drug company's to blame for the price they sell.

-Insurance companies. -PBMs.

It's the government's fault that I'm paying high prices.

-Wait, fuck! Wait, wait, stop doing that. -[notes playing]

This is like the most depressing version of Dance Dance Revolution.

-Stop doing that, please. -[music stops]

I'm gonna have a seizure.

These four love pointing fingers,

because if you can't figure out who to blame,

they can all keep making money.

This crisis has consequences. Every day, people are dying

because they can't afford basic medicine, but there is hope.

Congress has the power to break patents in an emergency.

They've never done it, but in the past...

the threat of breaking patents has forced drug companies to lower prices.

Right now, there could be enough political will to change things.

There seems to be momentum. Politicians across the political spectrum

have made drug pricing a priority, especially for the 2020 election.

Right now, there are two separate congressional committees

investigating drug pricing.

One run by a Republican, the other run by a Democrat.

Recently the executives

of seven major pharma companies�were asked to testify

at a Senate hearing about drug prices.

All seven initially declined to show up,

which was a pretty pancreas move, and by that, I mean,

those pharma execs are a bunch of indoor dicks, but...

then Senator Ron Wyden tweeted a veiled threat to subpoena them,

and all of a sudden the execs RSVP'd. If you don't know,

subpoena is the legal term for white people beef.

It's up there with, "Can I see the manager?"

It's a pretty powerful move.

Now, it's encouraging to see

that Congress is willing to use their power

to force pharma companies to explain themselves.

But the question is,

will Congress use their power to force them to do more?

I can only hope they listen to the millions of people suffering

and not the�$174 million

pharmaceutical manufacturers and PBMs spent on lobbying last year alone.

The burden can no longer fall on the shoulders of patients.

No one should have to beg for medicine or ration their treatment

or hit up the black market or rely on Ghostface Killah

to be the voice of reason.

I want to see justice be served. You know what I mean?

I want Congress and them to really get 'em.

I want the courts to get 'em, because people is dying.

I've talked about this for 20 minutes and somehow,

that was the clearest solution for this entire problem.

I want Congress and them to really get 'em.

I want the courts to get 'em

because people is dying.

Thank you, Ghostface.

[audience applauding, cheering]

Thank you guys so much. Good night!

[theme music playing]

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