Drug Manufacturers, Pricing, and Ethical Obligations

Date of Award

Fall 10-1-2021

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Kagan, Shelly


High prescription drug prices in the United States and beyond impede patient care, impoverish families, and severely strain institutional budgets. Drug manufacturers routinely launch new products at high prices, increase the prices of existing products, and engage in a range of activities that thwart competition. Yet, while patients grapple with whether today is the day they eat “cat food” or default on their mortgages (let alone have their lives cut short), and health systems are compelled to make difficult choices about program cuts, many drug manufacturers enjoy highly lucrative returns. With this juxtaposition, it is thus no wonder that the popular press, politicians, public interest groups, academics, and even industry insiders have explicitly or implicitly deemed drug manufacturers’ pricing conduct immoral. Critiques of drug manufacturers’ pricing practices are rhetorically forceful and intuitively compelling. However, though criticisms of drug pricing are pervasive, morally resonant language notwithstanding, these criticisms are rarely systematic or spelled out with precision sufficient to evaluate their logical veracity. Moreover, the philosophical literature on this pressing issue of drug manufacturers’ moral obligations is appreciably sparse. Despite being much maligned, there has been little extended analysis of moral critiques that are or could be leveled against drug manufacturers and how they price their products. Urgent questions, therefore, remain live: What are the most salient moral critiques of drug manufacturers? Do they hold up to sustained scrutiny? Drawing on principles based in commonsense morality, this dissertation examines these questions. It makes a good faith effort to articulate and systematize moral arguments critical of drug manufacturers and their pricing practices. It then subjects these critiques to sustained scrutiny. It seeks to provide analytical clarity to these critiques and associated policy debates by identifying where they miss and where they land. The dissertation identifies and evaluates three central and distinct strands of moral criticisms of drug manufacturers and their pricing practices. These are that drug manufacturers, through their pricing practices, (1) immorally fail to rescue patients; (2) immorally harm patients; and (3) immorally treat patients unfairly. It argues that many ways in which these criticisms can be understood are philosophically uncompelling. Nevertheless, not all criticisms wither under philosophical inspection. The dissertation’s analysis thus concludes that refined moral criticism of drug manufacturers and how they price their products can be appropriate. It provides normative credence to what many already believed: drug manufacturers likely do, at times, act immorally. Under relevant circumstances, they can harm patients and treat patients unfairly through anticompetitive conduct, and they can treat patients unfairly by pricing far in excess of affordability. Drug manufacturers could even be guilty of a failure to rescue those in need. As a high-stakes situation reverberating through households and institutional budgets, the price of prescription medications is rightfully morally charged and remains a live issue of immense political and moral importance. Drawing on this dissertation’s analysis, critics of drug manufacturers will be better placed to refine and promote their arguments in the service of drug pricing reform.

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