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.

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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.

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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.