The Insulin Pricing Crisis Becomes a Plotline on Designated Survivor

The Insulin Pricing Crisis Becomes a Plotline on Designated Survivor

-Craig Idlebrook

A presidential administration, albeit a fictional one, decisively takes on a pharmaceutical company over the high price of insulin, and even suggests a real-life policy fix for the insulin pricing crisis.

The third season of Designated Survivor, which follows the turbulent administration of Tom Kirkman, a former Cabinet member who assumes office after a terrorist attack, includes several plotlines about the promise and the failings of the pharmaceutical industry in America.

In the third episode of the new season of the political drama, which is now on Netflix, members of Kirkman’s staff focus on the issue of high drug prices in an attempt to help him in his first official presidential campaign. The president’s chief of staff, Mars Harper, asks staff member Isabel Pardo for suggestions of drugs which are priced unreasonably high.  

“We need to find the exact right test case, a medication way too expensive for something common and serious, preferably where people have died,” Harper says. Then, perhaps realizing how that sounds, he adds, “I am going to hell.”

Prado suggests Helmdale Pharmaceuticals, a fictional pharmaceutical company which has raised the price of Keziax, a brand of insulin, eightfold in the last decade. Some time later, Prado meets with Helmdale’s CEO at the White House and demands that the company lower the price of insulin.

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Here is where fiction and non-fiction collide. First, Prado suggests that the FDA could force Helmdale to bring down the price of insulin by using a provision of a very real 1980 law known as the Bayh–Dole Act, or Patent and Trademark Law Amendments Act. This act, which was largely focused on encouraging drug innovation, technically gives a federal agency which funds a drug’s development the ability to break the patent of a drug “when action is necessary to alleviate health needs which are not being reasonably satisfied” and when the patented product is not “available to the public on reasonable terms.”

Prado suggests the Kirkman administration has the power to use this act to break Helmdale’s patent on Keziak and give the drug to a competitor. The Helmdale CEO balks at this, and points out, factually, that this provision has never really been tested in court and would be challenged if utilized.

In response, Prado produces a tablet with a recorded interview of Nicole Smith-Holt, the real-life mother of Alec Smith, a young man who died from diabetic ketoacidosis because of insulin rationing. As the show notes at the end of the episode, this video, like many other similar testimonials throughout the season, was produced by documentary filmmakers to be included in the show; Smith-Holt was given no direction about what to say, but her real comments were included in the fictional world of the show.

In the video, Smith-Holt, who is now a leading activist in the #insulin4all movement, tearfully recounts how she lost her son because of insulin rationing and how much she misses him. In roughly one minute and a half of screentime, she is blunt in her criticism of the pharmaceutical industry.

“I have to live the rest of my life without my son,” she says, through tears. “A part of my soul is gone because the greedy people think that it’s okay to randomly increase the price of life-saving medications to the point where they’re unaffordable for the people who need them to stay alive. It’s unfair, it’s unethical, and it’s unjust, and it needs to end.”

Prado suggests that the CEO lower the price of the insulin voluntarily, or risk the release of Smith-Holt’s video and the administration taking action under the Bayh-Dole Act. The CEO is left in silence to contemplate this.

While the third season of Designated Survivor takes on the pharmaceutical industry in a bigger subplot about opioid addiction, and touches on several other medical issues, it does not return to the issue of insulin pricing. The viewer is left to assume this threat worked.

Back in the real world, many different strategies are being tried to compel insulin companies to mitigate the high price of insulin, from class-action lawsuits to state legislation to cap pricing for co-pays for the drug. However, Bayh-Dole has not often been discussed as a tool to combat the insulin pricing crisis at the federal level, which perhaps signals that it might remain a fictional remedy rather than a practical one.


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