An Arm and a Leg

One place you might assume is safe from prying ears is your therapy session.  But as more therapists struggle to negotiate with insurers, they’re turning to tech middlemen like BetterHelp and Headway that promise to take care of the insurance admin and match them with patients.  And these companies are sometimes recording and transcribing your sessions — and then turning around and sharing that data with social media companies and investors. And there are concerns that these confidential discussions could be used to train the next generation of chatbot therapists. So this week, we’re bringing you an episode from our pals at Organized Money, a show about corporate consolidation and monopolies, where they speak with Linda Michaels, a psychologist and co-founder of the Psychotherapy Action Network, about the tech companies sneaking into your therapy sessions and how we got here. And they share some good news: How one state, Illinois, passed a law in 2025 that could be a national model for encouraging more therapists to stay in-network, and ultimately, reduce reliance on these platforms.  For more on mental health coverage: Check out our episode about Abigail Burman, an attorney and expert on mental health “ghost networks” — lists of providers that turn out to be filled with inaccuracies, making it difficult for patients to get in-network care. Plus we have a whole guide from Burman on “ghostbusting” — AKA, getting your insurance to cover your mental health care. That’s in our First Aid Kit newsletter. Here’s a transcript of this episode. We’ll be back with more Arm and a Leg in a few weeks.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

It’s a case you’ve (probably) never heard of: This week, the Supreme Court is hearing oral arguments in Hikma v. Amarin — a legal battle that could impact how much you ultimately pay for prescription drugs.  Here’s why the case matters: As soon as a generic version of a brand-name drug comes to market, its price typically drops by half. Within 10 years, by more than 75%. Meaning: the sooner we have access to generics, the less we pay at the pharmacy counter.  But one of the fastest legal pathways for generic companies to get their drugs to market may be about to get a lot narrower – depending on how the court rules later this year. Amarin, a brand-name drugmaker, has accused Hikma, a generic company, of encouraging doctors to infringe on their patent for a drug called Vascepa.   The case revolves around the legal concept of skinny labels: a carveout in drug patent law that allows generic companies to bring drugs to market when one of the brand-name drug’s patents has expired, but others haven’t. And it raises the (unexpected) question of whether it’s OK for a generic drug company to call their product the generic version of something.  Legal experts help us unpack the nerdy details – including how this case came to be, and what’s at stake for both generic drug companies and anyone looking forward to one day paying less for an expensive brand-name drug.  Want to learn how these drug monopolies work – and came to be in the first place? Check out our previous episode: Why drugs cost so much, 101: Medicine monopolies Here's a copy of this episode's transcript.  Send your stories and questions. Or call 724 ARM-N-LEG. And of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

We’re always asking: Why do drugs cost so freaking much?  And it’s a complicated question. There are a bunch of reasons — to be sure. But in our reporting over the years, like our stories on insulin and tuberculosis drugs, experts cited one big reason over and over again:  The pharmaceutical industry wages sophisticated legal battles to keep monopoly control over their best selling, most lucrative drugs — blocking generic competition, and increasing their prices along the way.  How did it come to be this way?  In this first episode of a new series – what we’re calling An Arm and a Leg 101 – we’re doing a crash course in the history of the drug patent system. And the rags-to-riches story of one amazing guy is going to help us do it.  Al Engelberg got schooled in the Art of the Hustle at a young age, collecting dimes at an illegal bingo game on the Atlantic City boardwalk.  Later, he’d put those street smarts to use as he sat at the negotiation table in Washington D.C., hashing out the details of a law that would usher in the generic drug industry as we know it. Then made millions from the rules he helped write. And as he admits, his legacy is mixed.  On the one hand: The rules Al Engelberg helped write — a grand bargain between generic drugmakers and patent-holding brand pharma companies— unleashed the power of generic drugs to save Americans money.  Nine out of ten prescriptions written today get filled with a generic. On the other hand: In the process of making his fortune, Al Engelberg discovered loopholes, gaps, and perverse incentives in that grand bargain.  Gaps that allowed brand and generic drugmakers to profit by keeping generics for many hit drugs off the market.   So we now spend more than ever on medicine — and more than 20 percent of Americans report skipping their medication because they can’t afford it.  Al Engelberg, now 86, has spent the last 30 years — and millions of his own dollars — trying to close those gaps.  “I live in a world — a pharma world — where half the people think I’m dead, and the other half wish I was,” he tells us.  You can read more of Al’s story — plus his prescription for fixing the crisis of high drug prices — in his book, Breaking the Medicine Monopolies: Reflections of a Generic Drug Pioneer. And you can hear our earlier reporting on drug patents here: John Green vs. Johnson & Johnson (part 1) John Green vs. Johnson & Johnson (part 2) The surprising history behind insulin's absurd price (and some hopeful signs in the wild) Here's a copy of this episode's transcript.  Send your stories and questions. Or call 724 ARM-N-LEG. And of course we’d love for you to support this show. An Arm and a Leg 101 is made possible in part by support from Arnold Ventures.See omnystudio.com/listener for privacy information.

This year, the price of health insurance increased dramatically for millions of people. Tens of millions. Obamacare subsidies shrunk, and premiums skyrocketed.  People asked themselves: how on earth am I supposed to make this work?  Two of those folks — attorney Nicole Wipp and skate-shop owner Noah Hulsman — tell the story of how they chose among lousy options. Nicole chose to dump health insurance altogether — even though she could have found a way to pay for it. Noah chose to pay for coverage that sucks, because it’s all he can afford.  Each made their choice in the context of their broader stories: Noah is deeply rooted in Louisville, KY, and lives about a mile from where his grandmother started Louisville’s first skate shop, around the time he was born. Nicole’s story includes an expensive, life-threatening medical adventure a decade ago — and a series of choices that’s taken her family from Michigan to Hawaii to South Carolina.  Reporters with KFF Health News have been talking with dozens of people all over the country about these kinds of choices for their series on the health insurance crisis, Priced Out. KFF Health News senior correspondent Renuka Rayasam, who introduced us to Nicole and Noah after writing about their stories, joins us to reflect on what these stories mean.  Read more of Renuka Rayasam’s reporting: When Health Insurance Costs More Than the Mortgage It’s 2026 and You’re Uninsured. Now What? See omnystudio.com/listener for privacy information.

Hey, first! We’re looking for your help. Can you take a couple minutes and fill out our Audience Survey?  We’re dying to know more about the community that’s using this show — and about what’s working for you and what you’d like to see. Let us know! Today we’re switching it up. We’re sharing an episode from the new podcast Drug Story. In each episode, science journalist and self-described “public health nerd” Thomas Goetz goes deep on the story of a single drug — what it treats, how it came to be, and what it reveals about the business of health and disease.  On this episode: the EpiPen, a device you’ll find in classrooms, on airplanes, in glove compartments — basically everywhere — because the EpiPen can be a literal life-saver for people with severe allergies. And of course, the EpiPen is also one of the most infamous examples of pharmaceutical profiteering gone bananas.  That part of the story makes us especially geeked to share this episode.  And there are more threads here — on the drug’s discovery, on the science of severe food allergies, and on what researchers have learned about preventing them — that Goetz does a great job of weaving together.  If you like it, new episodes of Drug Story come out every week.  We’ll be back with more Arm and a Leg in a few weeks. Meanwhile, don’t forget to help us by filling out our quick survey. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.