As I understand it Gilead in particular seem to be pretty good about using those cold-hearted, “lifetime cost-effectiveness-ratio” sticker prices to effectively subsidize enormous quantities of affordable or free, high-quality drug in those poorer parts of the world that are bearing the brunt of the HIV epidemic. If the premise of insurance is pooling risk, is it inconsistent for the drug manufacturer to coldly calculate the “fair” price of the drug in proportion to its economic value—that is, the savings it brings over a given patient’s lifetime—then do their humanitarian discounting from that starting point?
They license their HIV patents to the UN Patent Pool so that generic manufacturers can produce them freely for low- and middle-income regions [0], they cover people’s insurance copays if their rich-world insurance bills for access to the drugs [1], and they provide access to the HIV drugs for free to uninsured people in the US [2].
As distasteful as the sticker prices are, I’ve always gotten the sense that you kind of have to play that twisted game if you’re going to get anything shipped at scale and stay in the pharma business. And that Gilead in particular have bent over backward both to focus their research on serious disease that primarily affects marginal and disadvantaged populations, and to make sure that their therapies actually make it out into the lives of the greatest possible number of patients.
[0] https://medicinespatentpool.org/