In North Carolina, we pride ourselves on being tough, fair, and fiercely protective of our neighbors. From the tobacco fields of the Piedmont to the tech corridors of the Triangle and the fishing docks of the Outer Banks, we don’t ask for special treatment — just a fair deal.
But when it comes to prescription drugs, Big Pharma isn’t playing fair.
They set sky-high sticker prices, shift the blame to everyone else, and gamble that hardworking families won’t notice.
Drugmakers establish list prices that anchor everything patients ultimately pay, and those prices in the United States are routinely two to four times higher than in other advanced countries across many therapies.
Insulin illustrates the gap: U.S. manufacturer prices have been measured at roughly 10 times those in a broad set of OECD countries, even before accounting for added out-of-pocket burdens on patients.
When manufacturers raise list prices, every actor downstream — plans, pharmacies, and patients — operates within that inflated starting point, making affordability a constant uphill battle.
States and regulators seeking real relief should therefore prioritize transparency, anti-price-gouging standards, and guardrails that curb unjustified launch prices and year-over-year hikes by manufacturers, not punitive measures against other parts of the drug supply chain that will make prescription costs higher and pharmacy access more prohibitive.
For minority and rural communities across our state, the stakes are even higher.
Black and Hispanic North Carolinians face higher rates of diabetes, hypertension, and cardiovascular disease, and many live in pharmacy deserts — areas with few or no nearby pharmacies.
If pharmaceutical manufacturers continue to set obscenely high prices at the jump, they could drive pharmacies out of business, exacerbating an already increasingly serious issue and collapsing the very institutions that bridge the gap for these communities with mail-order delivery programs, specialty drug coordination, and low-copay formularies that make lifesaving medicine accessible even in underserved areas.
North Carolina leaders have already pressed for stronger drug price transparency to hold manufacturers accountable, recognizing that families are forced into impossible choices when prices spike without clear justification.
Building on that approach can guide targeted reforms that shine light on pricing decisions, require justification for large increases, and support enforcement when companies fail to play fair.
The pharmaceutical lobby deploys substantial resources to shape policy debates, which makes it even more important that North Carolina’s reforms center on patients and the evidence about where prices originate.
Focusing on the true price-setters also helps insulate families from broader shocks — like trade or tariff moves that risk cascading into higher medicine costs — by emphasizing accountability for manufacturers’ pricing choices, not distractions downstream.?
Let’s follow the money. In the 2023–24 cycle alone, pharmaceutical PACs poured nearly $1 million into state and federal campaigns tied to North Carolina lawmakers.
Some of the same politicians who once called drug costs “a crisis” are now drafting bills that weaken the very companies that help negotiate drug prices down — written with help from Big Pharma’s lobbyists.
When these corporations host fundraisers, bundle donations, and fly legislators to retreats, they’re not buying “conversation” — they’re buying legislation.
Every dollar that goes to a lobbyist in D.C. or Raleigh is a dollar not going toward lowering the cost of medicine in Goldsboro, Wilmington, or Boone.
North Carolinians know a raw deal when they see one.
Big Pharma sets sky high prices to begin with, and we can’t let them shift the blame.
If lawmakers want to lower what people pay at the counter, they must tackle the source —pharmaceutical companies’ launch prices and price hikes — through transparency, justification standards, and enforcement that puts patients ahead of profits.
North Carolina families deserve reforms that hold price-setters accountable and finally bring prescription costs back within reach.
(Editor’s Note: A releated opinion column may be found here.)
Charlie Kolean has worked as a senior policy adviser for state legislators, multinational corporations, and think tanks. Mr. Kolean has been involved in politics for over a decade as an activist, candidate, political consultant, and party leader. He was a bundler on the Trump Finance Victory Committee, and is a member of the American Association of Political Consultants. Read more of his reports — Here.
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