The state of the HIV epidemic in the United States is a global embarrassment. Currently, we spend more than any other country per person on domestic HIV treatment, yet by almost every metric, our epidemic is worse than that of other wealthy nations. So why the discrepancy between cost and outcome? The problems are multifactorial, including systemic racism, classism, transphobia, and homophobia. Oddly enough, however, egregious price gouging by the pharmaceutical industry has gotten almost no attention, despite its central role in hampering America’s HIV response. High drug prices distort our nation’s fight against AIDS, forcing the health care system to pay massive markups to pharmaceutical companies and leaving relatively little for other vital services. As a result, we continue to line the pockets of pharmaceutical executives rather than addressing the broad social and environmental barriers to effective HIV treatment and prevention.