The good news is that new treatments for HIV, hepatitis C, cancer, and many other diseases have transformed the lives of patients. But the bad news is that some of these new medicines come with a huge price tag — a course of treatment can run tens to hundreds of thousands of dollars! And many people, especially in developing countries, simply cannot afford them.

Why are many of the newly developed life-saving drugs so insanely expensive?

tripfest_An_isometric_illustration_of_expensive_prescription__32083379-dfcd-471c-b707-710281991d3d_2.png

The patent system is greatly responsible for this. A medical patent, like other types of patents, is a government-granted right giving the developer ownership of an invention for 20 years. During this period, the developer can prevent others from making, using, or selling the patented item. They enjoy a monopoly and can charge an artificially high price to recoup development costs — and sometimes much more.

Decades ago, Dr. Jonas Salk opposed patenting the polio vaccine. When asked who owned the patent, he replied: “Could you patent the Sun?” Because it was never patented, the vaccine spread rapidly across the world, saving hundreds of thousands of children from paralysis or death. To this day, Salk’s question echoes as a moral challenge: Should anything essential to human survival ever be owned?

How Patents Create Medical Monopolies

When a pharmaceutical company invents a new drug, the patent clock starts ticking immediately — long before the drug hits pharmacy shelves. Clinical trials and safety reviews can take 10–12 years, so by the time the drug reaches patients, the company may have only a few years left to earn back billions in R&D costs. That pressure fuels sky-high launch prices and clever legal tactics to extend patent life.

tripfest_A_conceptual_infographic_showing_a_giant_patent_cert_2ee6d391-8a1f-404a-9234-9f8f2bef40ca_3.png

One of the most common tricks is “evergreening” — making minor changes like a new dosage, delivery device, or combination formula to file a fresh patent. Another is building “patent thickets,” dozens of overlapping patents that make it nearly impossible for generic makers to compete, even after the original patent expires.

Example:

The arthritis drug Humira once had more than 100 related patents, keeping competitors out for nearly two decades beyond its original term and earning over $200 billion for its maker.

The U.S. Patent System: Innovation at a Cost

Nowhere does the patent system flex its power more visibly than in the United States, home to many of the world’s biggest pharmaceutical companies. Here, patents are seen as the engine of innovation — without them, drug companies argue, no one would take the financial risk to develop new treatments.

But the U.S. also has no legal limit on drug prices and, until recently, even prohibited its largest public insurer (Medicare) from negotiating directly with companies. That means a company with a patent effectively controls the price of a drug — for as long as its monopoly lasts. The results are staggering:

A vial of insulin that costs about $5 to make can sell for over $100 in the U.S.
The same vial in Canada or Germany costs under $10, largely because those governments negotiate prices or set legal caps.
American patients often pay 8 to 10 times more for essential medicines than people in other high-income countries.

Even after a patent expires, lawsuits and settlements can delay generics for years, keeping prices high. And because the U.S. allows direct-to-consumer advertising — unlike most nations — companies spend billions convincing patients (and doctors) to choose brand-name drugs even when cheaper generics exist. It’s a system built on the belief that innovation thrives on profit. But for millions of Americans rationing insulin or skipping prescriptions, that innovation feels like a locked door.

When Patents Collide with Public Health

Sometimes, patent protection and public need clash head-on. In 2001, during South Africa’s devastating HIV/AIDS epidemic, 39 pharmaceutical companies sued the government for importing affordable generic drugs. Public outrage was so strong that the companies eventually dropped the case — and international law was amended to protect countries that break patents for public-health emergencies. That event led to the Doha Declaration, which reaffirmed that saving lives outweighs protecting profits.

tripfest_A_global_map_illustration_showing_high-priced_brande_4ad60137-d7db-45a7-a6af-a63bb41c878c_3.png

India’s Bold Stand: The Gleevec Case

India, home to a vast generic drug industry, has repeatedly challenged the idea that every incremental improvement deserves a patent. When Novartis sought a new patent for its cancer drug Gleevec, Indian courts said no — the drug wasn’t sufficiently innovative. The result? Indian manufacturers were free to produce a generic version that cost about $2,500 a year, compared to $70,000 in the U.S. That single legal decision made cancer treatment accessible to thousands and strengthened India’s reputation as “the pharmacy of the developing world.”

Negotiating the End of Monopoly

When a patent finally expires, the market opens to generic competition — and prices can fall by 80–90% within months. Countries like Germany and Japan actively negotiate prices after patent expiry, ensuring generics remain affordable and high quality. Emerging economies such as Brazil or China go further: they sometimes use compulsory licensing, allowing local firms to manufacture patented drugs when public health is at stake. These negotiations mark the transition from private monopoly to public responsibility.

The Moral Frontier of Innovation

New technologies — like gene therapy and AI-designed drugs — are testing the limits of the current patent system. Should a gene, an algorithm, or a life-saving molecule ever be owned by a single company? Some scientists propose open-license models, where discoveries funded by taxpayers must remain affordable worldwide.

Because a medicine that no one can afford isn’t a cure — it’s a missed miracle.