When Is The Price Of A Drug Unjust? The Average Lifetime Earnings Standard
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Updated: Jan 27, 2026

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1Ezekiel J. Emanuel ( zemanuel@upenn.edu ) is the Diane V. S. Levy and Robert M. Levy University Professor, chair of the Department of Medical Ethics and Health Policy, and vice provost for global initiatives, all at the University of Pennsylvania, in Philadelphia.
Abstract:
The majority of Americans believe that lowering drug prices should be the top health care priority for the federal government. Yet drug costs as a proportion of the country's medical expenditures have increased substantially in recent years. Because drugs are basic necessities, and because how much society should contribute toward providing basic necessities is a question of justice, policies regarding drug prices must fulfill principles of justice, not just economic efficiency. In this article I define a standard for when the price of a drug is unjust, using a cross-disciplinary ethical approach. Based on four principles, I propose the average lifetime earnings standard for affordability. According to this standard, a drug price is unfair if it exceeds 11 percent of the average American's disposable income. This suggests that current prices for many drugs are excessive and unjust.
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