From affordable to accessible: How the pharmaceutical industry transformed patient consumers into charity recipients.

Recent changes in healthcare pricing and financing have resulted in patients paying more out of pocket for their healthcare. As a result, more patients with insurance are being priced out of essential or desired medications. Pharmaceutical companies have responded by offering financial assistance programs for patients. Medical sociologists have productively used the concept of consumerism to describe the effects of markets on the provision of healthcare. But in this current context where financial assistance programs are increasingly important for patients seeking prescription drugs, what are the implications for medical sociological theories of patient consumerism? I use medical and economic sociology theories to analyze pharmaceutical executive testimonies in 34 federal US Congressional hearing transcripts prices from 1959 to 2020. Congressional testimony offers an ideal window into how these executives justify their prices and describe the implications for patients downstream in the healthcare system. I find that executives initially justified prices as fair and drugs as cost-effective because medications were an affordable form of healthcare. However, as drug prices rose, executives abandoned affordability arguments and instead argued drugs were accessible to patients though pharmaceutical company run financial assistance programs. Findings contribute to medical sociology by theorizing a system of corporate charity as the next phase of the capitalist US healthcare system and demonstrates how elite market actors (re)define downstream categories of consumers.