How Pharma Money in Congress Kept Insulin at $300 a Vial

Alec Smith died $300 short of a refill. The public record — FEC filings, lobbying disclosures, one Senate vote — explains why.

Alec Smith had $1,000 in his bank account. His next month of insulin and supplies cost $1,300.

He was 26, managing a restaurant in Minneapolis on about $35,000 a year — too much to qualify for Minnesota’s medical assistance, too little to afford a workable plan on the individual market. Twenty-seven days after he aged off his mother’s health insurance, he was found dead in his apartment. The cause was diabetic ketoacidosis, the predictable result of rationing a drug his body could not survive without.

Nothing about his death required a conspiracy. Pharma money in Congress isn’t hidden in secret letters or smoking-gun memos; it sits in plain sight in Federal Election Commission filings, lobbying disclosures, and roll-call votes. Viral videos keep inventing dramatic hearings and fabricated donor letters to tell this story. They don’t need to. The documented version is worse.

A Drug That Costs $10 to Make — and a Price Up 1,000%

The scientists who discovered insulin in the 1920s sold the patent to the University of Toronto for a dollar, on the principle that the drug belonged to the world. A century later, a vial costs less than $10 to manufacture. By early 2023, the three companies controlling roughly 90% of the global supply — Eli Lilly, Novo Nordisk, and Sanofi — had pushed list prices to $275 for Humalog, $289 for NovoLog, and $292 for Lantus.

Senator Bernie Sanders put the cumulative increase at more than 1,000% since 1996. The human cost of that markup is measurable. Researchers from Harvard Medical School, Hunter College, and Public Citizen analyzed the federal government’s 2021 National Health Interview Survey and published the first national estimate in the Annals of Internal Medicine: 1.3 million Americans — 16.5% of all adults prescribed insulin — rationed the drug in a single year. Among the uninsured, it was nearly one in three.

Alec Smith wasn’t an outlier. He was a data point in a pattern the pricing created.

The Lobby That Outspends Everyone

Follow the money upstream and the pattern stops looking accidental. According to OpenSecrets, pharmaceuticals and health products have spent more on federal lobbying than any other industry every year since 1999. In 2024, that meant $151 million across 139 companies and 738 registered lobbyists — close to two-thirds of whom came through the revolving door from government jobs.

The spending isn’t slowing. The industry poured $226.8 million into lobbying in the first half of 2025 alone, and PhRMA, its main trade group, set an all-time record of $38.2 million for the year. Nearly $132 million more has already been disclosed for the opening months of 2026.

The pharmaceutical industry has been the single biggest lobbying force in Washington for more than a quarter century — and its spending is still setting records.

The goodwill purchases extend past lobbying. PhRMA, Pfizer, Bayer, Merck, Eli Lilly, and Abbott each wrote checks of $500,000 to $1 million to the 2025 presidential inaugural committee, according to federal disclosures.

Checks for Two-Thirds of Congress

Campaign contributions are the retail side of the operation, and they are deliberately bipartisan. A STAT analysis of the 2020 election cycle found that 72 senators and 302 House members — more than two-thirds of Congress — cashed at least one check from the drug industry. Pfizer’s PAC alone funded 228 lawmakers. Amgen’s funded 218.

Whoever holds power gets the money. Mitch McConnell, then Senate majority leader, was that cycle’s single largest recipient, taking checks from 23 of the 25 company PACs in STAT’s survey. In the 2023–2024 cycle, with Democrats defending the law that authorized Medicare price negotiation, the flow tilted the other way: employees and PACs tied to pharmaceutical and health products gave $26.4 million to Democrats against $16.1 million to Republicans, per FEC data compiled by OpenSecrets.

KFF Health News, which has tracked pharma PAC giving for over a decade, described the industry’s donations during the 2021 drug-pricing fight as delivered “with surgical precision” — aimed at the moderate members whose votes would decide whether Medicare could negotiate at all.

This is not a one-party story. The checks follow the gavel, and both parties have cashed them.

Fifty-Seven Votes for Cheaper Insulin Weren’t Enough

If you want a single documented moment where the money met the floor, it came on August 7, 2022. Senator Raphael Warnock’s provision capping insulin copays at $35 a month for the privately insured was part of the Inflation Reduction Act until the Senate parliamentarian ruled it outside the bounds of reconciliation. Keeping it in the bill required 60 votes.

It got 57. Every one of the 43 votes to strip the cap came from Republicans; seven of their colleagues — including, notably, Louisiana’s John Kennedy — crossed over to defend it. Finance Committee chair Ron Wyden’s verdict: “Republicans have just gone on the record in favor of expensive insulin.”

The Medicare-only version of the cap survived. Seniors got $35 insulin. Younger adults — who ration at nearly twice the rate of those over 65 — got nothing.

The Hearing That Actually Happened

Nine months later, the confrontation that viral videos keep fabricating took place in real life, on camera, with a transcript. On May 10, 2023, the Senate HELP Committee under Sanders put the CEOs of Eli Lilly, Novo Nordisk, and Sanofi at the witness table alongside executives from CVS Caremark, Express Scripts, and Optum Rx — the pharmacy benefit managers handling about 80% of U.S. prescriptions.

By then the dam had cracked. That March, under what Sanders called the combined pressure of public outrage, a grassroots movement, and government action, all three manufacturers had announced cuts:

• Eli Lilly: Humalog down 70%, from $275 to $83, with its generic lispro priced at $25 a vial
• Novo Nordisk: NovoLog down 75%, from $289 to $72
• Sanofi: Lantus down 78%, from $292 to $64

Sanders opened by naming people who died rationing insulin — Alec Smith among them — then pressed each CEO to commit to never raising insulin prices again. Only Lilly’s David Ricks said yes. “We just don’t want words. We want actions,” Sanders told the panel.

What January 2026 Changed — and What It Didn’t

The Inflation Reduction Act’s bigger weapon detonated this year. On January 1, 2026, Medicare’s first negotiated drug prices took effect, covering ten drugs used by roughly 9 million enrollees. NovoLog and Fiasp, the Novo Nordisk insulins, fell from a $495 list price to a negotiated $119 a month — a 76% cut from a program the industry spent years fighting in court. The federal government projects $6 billion in Medicare savings and another $1.5 billion in out-of-pocket savings for beneficiaries in 2026 alone. Round two, effective 2027, reaches Ozempic and Wegovy.

And yet the architecture that killed Alec Smith remains intact for everyone the law doesn’t touch. The federal cap for private insurance that died 57–43 still isn’t law. The uninsured — the group rationing at the highest rate — depend on manufacturer programs and a patchwork of state laws like Minnesota’s Alec Smith Insulin Affordability Act, passed in 2020, which guarantees an emergency 30-day supply for a $35 copay. His mother, Nicole Smith-Holt, had to build that safety net out of her son’s name.

Meanwhile, the industry’s lobbying totals keep setting records — because the next fight, over which drugs get exempted from negotiation, is already underway.

Pull quote: Nothing in this story was hidden. The checks were disclosed, the votes were public, and Alec Smith still died $300 short of a refill.

The Scandal Is That It’s All Legal

The fabricated version of this story needs a manila folder, a secret letter, a politician fleeing a hearing room. The real version needs none of it. Every number above sits in an FEC filing, a lobbying disclosure, a committee transcript, or a CMS fact sheet. The system that priced a $10 vial at $300 wasn’t corrupted in the dark. It was financed in public, one disclosed check at a time.

That’s the part worth sitting with: transparency, by itself, saved no one. Pressure did — hearings, lawsuits, ballot-box fear, and a mother who refused to stop saying her son’s name.

If this kind of documented, no-invention breakdown is useful to you, follow for more, and share this with someone who still thinks drug pricing is too complicated to understand. The records are public. Somebody just has to read them.