Medical Patent Reform (Mike Lee)

March 24, 2025

Re: Medical Patent Reform

Dear Senator Lee,

I’m writing to express my appreciation for your constitutional leadership—and my concern about the growing dysfunction in our healthcare system and the intellectual property laws that distort access to it. I’ve long admired your commitment to the Fourth Amendment. Your opposition to warrantless surveillance, your efforts to reform FISA, and your defense of civil liberties reflect a principled and courageous stand in a political climate that too often favors expediency over rights. As someone who values liberty deeply, I’m grateful for your leadership in this area.

My political journey began from a strong free-market perspective, heavily influenced by the writings of Frédéric Bastiat. I have long believed that markets, when functioning properly without government interference, are powerful tools for prosperity and innovation. For several years, however, I felt politically disenfranchised. After the 2016 and 2018 elections, it seemed celebrity status mattered more than principles in both state and federal races. Local elections often presented few, if any, real choices—and even basic information about candidates was hard to come by. I felt powerless to affect the changes I cared about, so I disengaged.

I never imagined I’d end up reliant on Medicaid. But in September 2019, I suffered a major stroke while in my final semester at Utah State University working toward a bachelor’s in Electrical Engineering—at 27 years old. I lost much of the ability in my right hand to do basic tasks. My sleep became severely disrupted—we eventually identified it as a circadian rhythm disorder. Blood thinners triggered gastrointestinal issues, which revealed Crohn’s disease—another lifelong condition that had gone undiagnosed. My stroke shattered the trajectory of my life.

I found myself dependent on a system I once wanted to dismantle. That realization came into sharp focus when I learned that a three-month supply of Eliquis—medication I now rely on to prevent another life-threatening stroke—would’ve cost me over $1,600 out of pocket—if not for government support. I am terrified to imagine where I’d be without that safety net. It seemed incomprehensible that a medicine relied on by so many—including myself—could cost so much. I understand that medical research is expensive—but the scale of the price inflation felt inexcusable. So I began digging into Eliquis because it had suddenly become personal.

Eliquis (apixaban) is a textbook example of a drug whose price is not determined by market forces but by regulatory privilege. Eliquis was developed by Bristol Myers Squibb and Pfizer and approved by the FDA in 2012. Despite over a decade on the market, it remains under U.S. patent protection. The original patent expires in 2026, but it has been surrounded by a dense ‘patent thicket’—overlapping secondary patents on minor formulation tweaks, manufacturing methods, and more. These don’t extend the core patent directly, but they serve to deter competition through threatened litigation. Even when generic challengers might win in court, the cost of fighting makes the drug functionally inaccessible—extending exclusivity potentially until 2031 or beyond.

While a three-month supply can cost over $1,600 at retail, according to ChemAnalyst, by the end of Q4 2022 apixaban’s cost was $3,252,200 per metric ton, which equates to about 1.6 cents per 5 mg tablet for the active ingredient. Accounting for excipients, labor, packaging, and distribution, I estimate that total manufacturing costs remain on the order of a few dollars per month’s supply. Even allowing for reasonable profit margins, the U.S. retail price represents an 80x–100x markup over production costs.

Eliquis is not unique, but it’s a particularly clear—and personal—example of how patents create artificial scarcity, suppress competition, and impose enormous costs on patients and taxpayers alike. This isn’t limited to pharmaceuticals. Patented monopolies in medical equipment—from insulin pumps to MRI machines—often inflate costs far beyond their actual production or maintenance. For those who rely on it, Eliquis is not optional—it’s survival.

I’ve come to recognize that healthcare is a deeply distorted market, shaped by legalized monopolies (patents), the imbalance of knowledge between insurers, providers, and patients—where patients often don’t know what treatments they need, what options exist, or what anything will cost—and regulatory barriers that protect entrenched interests rather than the public. If we want to restore competition, we need to rethink how we handle medical research and innovation. I believe we should fund research publicly—and in many cases, we already do via grants. That funding should be transparent and priority-driven. Then, any qualified business should be able to produce and distribute those treatments in a truly competitive economy.

Health insurance companies also insert themselves into medical decisions—approving or denying treatments based on cost rather than medical necessity. In doing so, they effectively practice medicine without holding medical licenses, overriding the judgment of trained physicians. This is yet another example of how financial gatekeepers distort the healthcare market in ways that would never be tolerated in a truly free and competitive system.

Healthcare is not like other goods or services. Most people don’t choose when or how to engage with the healthcare system—it often comes in moments of crisis, with limited ability to compare prices or walk away from bad deals. That alone would justify scrutiny. But what makes the situation worse is the role of patents in restricting competition and inflating the price of life-saving drugs.

Pharmaceutical patents, originally designed to incentivize innovation, are now often used to block competition far beyond what is reasonable. For decades monopoly pricing has inflated the cost of life-saving medications like insulin and anticoagulants. This is not due to production cost, but because legal protections allow it. This isn’t the free market—it’s a system of government-backed exclusivity—a monopoly. The same holds true in the medical device market, where overlapping patents on hardware, software, and servicing similarly stifle competition and inflate costs. Generic competition is blocked in the U.S., even though Eliquis sells for just $10–$30 per month in Canada and India.

This isn’t about recouping R&D costs—it’s about maximizing profit through regulatory capture. While pharmaceutical companies cite high development costs, estimates typically range from $1.5 to $2.5 billion. Yet, in just five years, Eliquis has generated over $27 billion in revenue for its manufacturers—meaning those costs have been repaid many times over—yet the monopoly pricing persists. It’s also worth noting that much of the foundational research behind new drugs is already funded by NIH grants and public institutions, while private companies are still granted “exclusive” rights to profit from the final product because, while the government retains certain rights to use patents it funds—it rarely asserts them to challenge monopoly pricing.

In Bastiat-style logic, all Americans benefit equally from medical science—even if they never use a particular drug—the knowledge advances us all. Government must benefit everyone equally—not privileged winners at the expense of others. Funding research upfront and letting the free market handle distribution is far more consistent with liberty than granting exclusive monopolies that distort competition and harm the public. Furthermore, by paying at the beginning of the cost chain, we avoid the inflated, compounded costs we now face at the end—costs that are currently passed on to taxpayers year after year.

What makes more fiscal sense? Paying $2 billion upfront to develop a drug through publicly funded research, or paying $27 billion every five years through Medicare, Medicaid, and other downstream health reforms—potentially in perpetuity—if patent exclusivity keeps getting renewed? The latter is not just inefficient, it’s unsustainable. Public investment without public return becomes a burden, not a benefit.

After researching how the legalized monopoly of patents benefits pharmaceutical companies—how they double dip by receiving public funds to develop new drugs, then charge taxpayers again through Medicare and Medicaid—I have no sympathy for their business model.

It is indefensible—legalized extortion.

In the same way that you’ve pushed back against surveillance overreach in defense of our liberties, I ask that you consider pushing back against the monopolistic overreach in healthcare that threatens both our financial well-being and access to care. Healthcare reform doesn’t have to mean more bureaucracy—it can mean less: fewer barriers to entry, fewer rent-seeking monopolies, and more freedom for patients and providers alike.

Thank you for your service and your commitment to principle. I urge you to take a public stance on this issue or help advance legislation that moves us toward freeing medical science. I recognize that abolishing medical patents may not yet be politically feasible—but it remains a goal worth striving for.

In the meantime, I hope you will consider supporting incremental reforms that:

• Shorten exclusivity for publicly funded patents, or make them subject to compulsory licensing
• Curb abuse of secondary patents and litigation tactics that delay generic competition
• Ensure the public receives a return on publicly funded research
• Promote open-access manufacturing to allow competition from qualified producers
• Assert the government’s rights to use patents it helps fund when monopoly pricing persists
• Encourage transparency and prioritize funding based on public health impact

These are achievable, principled reforms that would reduce costs, improve access, and move us closer to a truly free and competitive healthcare system.

Sincerely,

John Call
[Contact information redacted from public version for privacy]