Why Legacy Treatments Are Becoming Shockingly Expensive

In recent years, a surprising shift has taken place in healthcare economics: the steep rise in prices for legacy treatments. Once considered cost-effective and broadly accessible, these older therapies, from basic insulin formulations to time-tested cardiovascular drugs, are becoming shockingly expensive. Unlike high-tech gene therapies or the latest cancer treatments, these medications are not new. They’ve been on the market for decades. So why are their prices spiraling out of control?

The answer lies in a mix of broken market dynamics, regulatory blind spots, and strategic pricing by manufacturers who face little competition. For health insurers, providers, and policymakers focused on value-based care, the escalating cost of legacy therapies is more than a budget issue; it threatens to undermine affordability and access to essential medicine. 

In this post, based on our Playbook "Before It Hurts", we explore why legacy treatments are becoming more expensive, how the Inflation Reduction Act (IRA) aims to curb this trend, and what it means for healthcare cost transparency and future care strategies.

The Rise and Fall of Legacy Treatments 

Legacy treatments refer to medications and therapies that have been in clinical use for a long time, often decades. These include widely prescribed drugs such as insulin, statins, beta-blockers, asthma inhalers, and early-generation antidepressants. Their formulas are well-established, and most are off-patent, meaning they should, in theory, be low-cost and widely accessible. For a long time, legacy medications and treatments were believed to have: 

• Proven efficacy and safety: These drugs have stood the test of time and have a strong evidence base.
• Known side-effect profiles: Decades of use provide a predictable therapeutic window.
• High patient familiarity: Both patients and providers are often comfortable with these treatments.

However, recently, legacy treatments have become more and more prone to: 

• Price volatility despite age: Many legacy drugs have seen significant cost increases, often due to market consolidation or lack of generic competition.
• Outdated delivery formats: Some formulations (e.g., syringes vs. auto-injectors) haven’t evolved with modern patient needs.
• Opaque pricing structures: Even off-patent drugs can remain expensive due to distribution monopolies or lack of pricing transparency.

This paradox, where tried-and-true treatments become financial burdens, has become a growing concern for both patients and health insurers. 

The Insulin Case: When Essential Becomes Inaccessible

Insulin is a prime example of a legacy therapy where price goes against logic. Although the original patent for insulin expired decades ago, prices for certain formulations have tripled over the past 15 years. According to the study published in the Annals of Internal Medicine,  more than 16% of diabetes patients who take insulin either skipped their prescribed doses, took less than needed, or delayed buying more. 

According to Precedence Research, the global insulin market was valued at approximately USD 29.73 billion in 2024 and is predicted to increase to approximately USD 107.36 billion by 2034. It is dominated by three multinational manufacturers, Eli Lilly, Novo Nordisk, and Sanofi, who control 99% of the market by value and 96% by volume, which is one of the most important contributing factors to the price increase. Another major contributor to price inflation is the shift from less expensive human and animal insulin to costlier insulin analogs. This shift has led to increased global spending and made insulin less affordable for both individuals and health systems.

Over the 10 years from 2006 to 2016, the cost of insulin in the U.S. climbed to $255 for 10 mL Humalog, a 264% increase. By 2017, it reached $275 before increasing public scrutiny and legislation to cap prices in certain states stopped the climb. What is interesting is that the cost to produce insulin remained relatively constant. In 2023, an associate professor of medicine at Yale said that production costs of 10 mL Humalog were estimated to be between $2‒4.

To summarize, the leading factors are:

• Limited generic competition: Complex manufacturing processes for biologics like insulin delay the entry of cheaper alternatives.
• Opaque pricing models: Pharmacy benefit managers (PBMs) and rebate structures often obscure the real cost.
• Market consolidation: A handful of manufacturers dominate the insulin market, allowing price coordination.

This alarming trajectory highlights why insulin price increases have become symbolic of the broader crisis in healthcare affordability.

The Legacy Therapy Paradox

One of the great ironies in modern medicine is that newer drugs often have more pricing oversight than older ones. Legacy therapies tend to slip through the cracks of policy reform, even as their market monopolies grow stronger.

Examples include:

• Albuterol inhalers, a staple for asthma treatment, now cost patients hundreds of dollars annually despite decades on the market.
• Statins, like Lipitor, saw post-patent price increases due to brand-stacking strategies and authorized generics.
• Chemotherapy agents, once generic, have had cost spikes due to production shortages or exclusive licensing deals.

The problem isn't just the price hikes themselves but the systemic lack of healthcare cost transparency that allows them to continue. For insurers, this creates growing uncertainty in risk calculations and care cost projections, which only adds to the healthcare crisis topic that we covered already. 

What This Means for Payers and Digital Health Platforms

Legacy drug inflation is not only a pharmaceutical challenge; it has become a pressing concern for insurers and digital health platforms striving to deliver affordable, value-based care. As digital platforms increasingly influence patient behavior, guiding users toward healthier habits, chronic disease management, and adherence to long-term therapies, rising drug prices threaten to disrupt these care journeys. When users cannot afford essential medications, they may delay or abandon treatment, undermining outcomes and increasing future costs.

For digital platforms and payers, this creates an urgent need to embed healthcare cost transparency directly into the user experience. This includes:

• Displaying up-to-date medication pricing and cost-effective alternatives.
• Identifying users likely to face medication non-adherence due to financial barriers.
• Integrating discount programs, vouchers, or formulary tools to lower out-of-pocket costs.
• Encouraging preventive interventions that reduce downstream reliance on high-cost, legacy treatments.

Ultimately, addressing drug affordability within digital health ecosystems is not just a service upgrade; it is a critical lever for improving health outcomes and cost efficiency across the care continuum.

How The Inflation Reduction Act Aids The Situation Now

The Inflation Reduction Act of 2022 represents a pivotal effort to control high drug prices, with important implications for legacy therapies. While the legislation is centered around Medicare, its provisions could shift pricing expectations industry-wide.

• Price negotiations: Medicare is now authorized to negotiate the prices of select high-cost, long-standing drugs for the first time.
• Inflation rebates: Manufacturers are required to offer rebates when price increases surpass the rate of inflation, encouraging more measured pricing strategies.
• Out-of-pocket caps: By 2025, Medicare enrollees will benefit from a ceiling on annual prescription drug expenses, offering more predictability and protection.

Although limited in scope, these reforms set a precedent for broader healthcare cost transparency. They challenge pharmaceutical companies to defend longstanding price hikes and may prompt faster adoption of biosimilars and generics, thereby easing the burden on health systems and insurers alike.

What Are The Key Strategies for Price Reduction of Legacy Therapies

To tackle the escalating costs of legacy treatments, healthcare stakeholders can deploy several targeted strategies:

• Encourage biosimilar and generic competition: Streamlining regulatory pathways and offering incentives can accelerate market entry of affordable alternatives.
• Implement international reference pricing: Benchmarking U.S. drug prices against global standards can exert downward pressure on domestic pricing.
• Increase price transparency: Requiring pharmaceutical companies and PBMs to disclose pricing structures would reduce opacity and enable informed decision-making.
• Public-private manufacturing initiatives: Government-backed drug production initiatives, such as Civica Rx, can introduce cost-effective generics into markets dominated by few players.
• Formulary reform and value-based pricing: Aligning drug prices with clinical outcomes can ensure fair compensation without excessive markups.

These approaches, combined with the broader push for healthcare cost reform, can restore affordability and fairness to legacy treatment pricing.

How Thryve Supports These Strategies 

The rising cost of legacy therapies is a hidden but growing threat to sustainable care delivery. While newer treatments attract headlines, it's the everyday medications that millions rely on that are quietly slipping out of reach. For insurers, health tech platforms, and policymakers, tackling this issue means more than cost control; it means preserving access and building a foundation for value-based, preventive care.

Thryve is committed to powering digital health solutions that support long-term health, early risk detection, and care continuity. With our API, health organizations can rely on: 

• Seamless Device Integration: Easily connect over 500 other health monitoring devices to your platform, eliminating the need for multiple integrations.
• Standardized Biometric Models: Automatically harmonize biometric data streams, including heart rate, sleep metrics, skin temperature, activity levels, and HRV, making the data actionable and consistent across devices.
• GDPR-Compliant Infrastructure: Ensure full compliance with international privacy and security standards, including GDPR and HIPAA. All data is securely encrypted and managed according to the highest privacy requirements. 

We help platforms guide users toward healthier, more affordable outcomes, whether through prevention or smarter use of legacy therapies.

Book a demo with us to discover how Thryve can help your platform address legacy treatment inflation and power data-driven, cost-effective health solutions.

Download our Playbook for free here!