In North Carolina, we pride ourselves on being tough, fair, and 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, and gamble that hardworking families won’t notice.
Drugmakers establish list prices that anchor patient cost, and those prices in the United States are routinely two-to-four times higher than in other advanced countries across many therapies. Insulin prices, for example, have been measured at roughly ten times those in a broad set of OECD countries, even before accounting for added out‑of‑pocket expenses.
When manufacturers raise list prices, each actor downstream (plans, pharmacies, and patients) must operate from an inflated starting point. States and regulators seeking real relief should therefore prioritize transparency, anti‑price‑gouging standards, and guardrails that curb launch prices and year‑over‑year hikes by manufacturers.
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, for example, and many live in “pharmacy deserts” (areas with few or no nearby pharmacies). If pharmaceutical manufacturers continue to set high prices at the jump, they could drive pharmacies out of business, exacerbating a growing issue and threatening 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 instead of downstream distractions.
Let’s follow the money. From 2023–24, 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 with help from Big Pharma lobbyists that weaken the companies that help negotiate lower drug prices. 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 going against lowering the cost of medicine in Goldsboro, Wilmington or Boone.
North Carolinians know a raw deal when they see one. Big Pharma sets the high prices and we can’t let them shift the blame. If lawmakers want to lower counter costs, they must tackle pharmaceutical companies through transparency, justification standards and enforcement that puts patients ahead of profits.
North Carolina families deserve reforms that hold price‑setters accountable and bring prescription costs back within reach.
Orrick Quick is co-host on Fox’s “The Preachers.”
