In 2017, Nicole Smith-Holt's son was forced to ration insulin because of rising costs. He died shortly after. To raise awareness about the rising cost of insulin, Smith-Holt joined a group called Caravan to Canada, which uses shuttles from the United States to Canada for a cheaper version of the medication. While the price of insulin in Canada was $30 per vial, the same medication in the United States, under a different name, was $320 per vial. According to Smith-Holt, most people in the group saved $3000 for three months of insulin.

Traveling to another country for affordable medication is one of the grim realities of the American healthcare system. Although policymakers have attempted to reduce the price of insulin through price caps and cuts, insulin prices have nonetheless dramatically risen over the past few decades: the cost for one vial of Humalog (a fast-acting type of insulin) rose from $21 in 1996 to $182 in 2024. Without good insurance coverage, insulin prices pose an extreme financial burden for poorer Americans. Many are forced to ration their stock of insulin, and some–in the case of Smith-Holt's son–die. 

What, then, accounts for these exorbitant prices? The answer is complex, but drug patents are a main contributor. When a pharmaceutical company develops a new drug, they can apply for a patent that grants it exclusive control over the drug's sales for a period of up to twenty years. Theoretically, patents incentivize drug research by allowing a company a period of time to recoup the money they spent on research and development. In reality, drug patents often create pharmaceutical monopolies that gate-keep new competitors from entering the market. This incentive-based model also introduces another problem: if the end goal is profit, then widespread diseases with a guaranteed consumer base will be targeted by companies for drug production, compared to uncommon diseases that are difficult to treat, such as amyotrophic lateral sclerosis (ALS). 

A company can not only patent the chemical formula for a drug but also the methods of its distribution and use. Although insulin has been around for almost a century, it has been difficult to introduce a true generic alternative (a version that is slightly different but with similar effects) because companies have heavily patented everything relating to insulin products. Experts call these roadblocks "patent thickets," which make it extraordinarily difficult for any large company to be challenged in the drug market. 

There is a clear moral argument to be made in favor of regulating drug patents, but there is also a compelling economic argument. Policymakers have attempted to reduce the price of insulin through price ceilings, but they run the risk of harming producers and causing supply shortages. The best solution to exorbitant drug prices is to introduce cheap, generic alternatives into the market and let the equilibrium price naturally lower in response. Consumers would buy the alternative, and large companies would be forced to lower their prices in response. However, because drug patents make it possible to limit competition, a single company or group of companies usually controls the entire market. For all the praise that a free market society has, the drug patent system reveals a system of production that prioritizes capital gain over humanitarian effort.