digicomphoto/iStock(WASHINGTON) — A House hearing on the affordability of insulin turned tense Wednesday, as visibly frustrated lawmakers repeatedly pressed pharmaceutical executives to explain how a drug patented for $1 ballooned to as much as $280 per vial for Americans.

The hearing, by the House Energy and Commerce oversight and investigations subcommittee, was a rare display of bipartisanship as both Republicans and Democrats chastised the nation’s three biggest insulin makers for high list prices.

For their part, the company executives returned repeatedly to carefully scripted talking points. List prices can be high, they said, because of a convoluted system of rebates negotiated with prescription benefits plans. The officials also said that their companies were using much of their profits to develop other innovative products that would benefit diabetic patients. And they noted that their companies offered special pricing programs for people who qualify.

But lawmakers like Democratic Rep. Jan Schakowsky of Illinois were having none of it. At one point, Schakowsky suggested illegal price collusion might even be in play, calling insulin costs “curiously close” and declaring “you’re in trouble.”

“I don’t know how you people sleep at night,” said Schakowsky, D-Illinois.

“If you think you can out-talk us without any transparency, without any accountability, I just want you to know your days are numbered,” she said.

Kathleen Tregoning of Sanofi, which makes Lantus, said the company will start as of June offering uninsured patients the ability to access insulin for $99 a month. But Rep. Joe Kennedy said the companies only seemed to be moving toward lowering costs when facing pressure from the public and potential regulation from Congress.

“No one should be rationing insulin,” Tregoning said at one point.

“And they do every day!” Kennedy, D-Mass., interrupted.

Unlike Type 2 diabetes, which can be controlled by a person’s diet, people with Type 1 diabetes need daily insulin injections to regulate their blood sugar.

The Senate Finance Committee this year launched a bipartisan investigation into insulin prices, citing skyrocketing prices. According to that panel, the insulin drug NovoLog cost 87 percent more in 2019 compared to 2013, while Sanofi’s Lantus drug jumped 77 percent. And Eli Lilly’s drug Humalog increased 585 percent between 2001 and 2015.

Republican Rep. David McKinley said he couldn’t understand why a drug that had been around for nearly 100 years would suddenly spike in cost. The inventors of insulin originally sold the patent to the University of Toronto for a single dollar.

“I’m a strong, strong supporter of innovation,” said McKinley of West Virginia. “But help me out a bit … Innovation is supposed to drive the price down, not up.”

Doug Langa, president of Novo Nordisk Inc., which makes NovoLog, said drug companies are researching innovative ways to make life easier for diabetics patients, such as limiting the number of shots they need per day. He also said there were “perverse” incentives when it comes to pricing, noting the $18 billion a year his company spends on rebates, discounts and fees.

“The higher the rebate, the higher the list price,” he said.

Tregoning of Sanofi said the money negotiated through rebates don’t always make it back to the customer.

“We don’t have visibility on how those rebates are used,” she told the panel.

Rep. Diana DeGette, who chaired the hearing, said: “it seems to me what is happening is that every component of the drug system is contributing to an upward pressure on the drug price.”

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