“The greed is astounding, it’s sickening, it’s disgusting,” said Rep. John Duncan (R-Tenn.) as he summed up his thoughts during the House Oversight and Government Reform Committee’s hearing to plumb the surging price of life-saving EpiPens. “And I am a very conservative, pro-business Republican.”

The rest of the committee was equally disgusted, but the hearing still dragged on for nearly six-and-a-half hours into the late evening Wednesday. Throughout, Congress members on both sides of the aisle grilled and chastised Heather Bresch, CEO of Mylan Inc., maker of EpiPens. With only one small competitor, Mylan holds 90 percent of the market share on epinephrine auto-injectors, which reverse deadly allergic reactions. Since buying the EpiPen in 2007, the company has raised the price 15 times, totaling a 500-percent increase. EpiPens went from roughly $50 each to $608 for a pack of two. Millions of people—mostly children—must constantly have access to a pen. During the hearing, several congress members spoke of the countless teary parents they have spoken with who are struggling to afford the devices they have no choice but to buy.

Yet, while consumers were grappling with medical bills, Bresch saw her company’s profits soar, as well as her own salary. Her compensation rose from $2.4 million in 2007 to nearly $19 million in 2015—a point Duncan was happy to clarify after Bresch told the committee that her current salary was around $18 million.

“Ms. Bresch made $18,931,068 in 2015,” he pointed out. “I suppose when you get to salaries of that level, over time it’s easy to forget an extra $931,068.”

But Bresch didn’t wither under the harsh scrutiny; rather, she defended the company’s pricing, even stating on several occasions that she “could not be more proud” of Mylan’s work. In her testimony and responses, Bresch painted the company as humanitarian, committed to educating consumers about deadly allergic reactions and the need for epinephrine auto-injectors to be stocked in schools and other public places. She also blamed the complexities of the American healthcare system on obfuscating drug pricing and argued that the EpiPen has not been the cash cow it appears to be. She testified that the company only makes a measly $50 in profit from each pen.

Yet, when pressed on the math behind that figure—and several others—Bresch gave incoherent and conflicting responses. At various times, she said she didn’t know key figures, including the total amount of profits Mylan makes from EpiPen sales.

“She knew exactly what the hearing was about,” ranking committee member Elijah Cummings (D-Md.) said after the hearing. “But she didn’t provide any answers.”

Bresch did answer one question, however: whether she had any regrets. She testified she regretted not anticipating the financial woes of her customers.

“You raised the price, what did you think was going to happen?” Committee Chairman Jason Chaffetz (R-Utah) asked.

“We raised the price over eight years,” Bresch responded, suggesting perhaps that the gradual increase might have gone unnoticed.

Fuzzy Math

Bresch arrived at the hearing armed with a pile of large charts and graphs, which several congress members stated were unclear and condescending. One chart laid out the profit breakdown of EpiPens and became a sticking point during the hearing.

The chart shows how a $608 EpiPen two-pack breaks down to only a $100 profit (or $50 per pen) for Mylan. After rebates and discounts to pharmaceutical managers and suppliers, Mylan brings in an average of $274 per two-pack, according to Bresch. She reported that the company sells 4 million two-packs a year, which would make the revenue about $1.1 billion. But after Mylan pays its manufacturing partner ($69 per two-pack) and covers undefined costs ($105), only $50 per pen is left as profit.

Making $50 of profit on a product that costs just a few dollars to make (epinephrine alone is a generic drug, and a dose costs less than a dollar) might seem like a healthy profit margin to most. However, Bresch downplayed it as meager.

Chaffetz wasn’t convinced, suggesting that she was muddying their actual bottom line. He asked for clarification on what the costs actually were, which Bresch said she would try to give him within 10 days. He was also confused by what Bresch referred to as profit, pointing out that in a letter to the committee Bresch had written that the $50 is put toward facilities maintenance and the costs of research and development. He was keen to know which line in the chart included executive pay, which totaled 300 million over the past five years. After some back and forth, Bresch said that employee and executive compensation isn’t included in the chart and that the actual profit was less than $50 per pen.

“We would expect a very professional presentation on your P&L [profits and losses], and these dumbed-down versions here do not make sense,” he said.

Cummings echoed his frustration. “When Mr. Shkreli appeared before us, he took the fifth,” he said, referring to Martin Shkreli, the former CEO of Turing pharmaceutical, another company that dramatically raised the price of a life-saving drug. “And to be frank with you,” Cummings went on, “you might as well have taken the fifth, too, with the kind of information we’ve gotten here today.”

Humanitarians

The committee was equally annoyed with Bresch’s response to her customers' financial woes and outrage, a response where Mylan expanded customer assistance programs and offered them a generic EpiPen. The generic will be the exact same product, made the exact same way, except sold in a box that isn’t labeled with the brand name “EpiPen.” Bresch said Mylan will offer the generic “direct” to consumers for the low price of $300 for a two-pack.

Chaffetz was quick to point out that if Mylan sold the generic directly to customers for $300, its revenue would be higher than the $274 per two-pack average it was getting for the brand name version. Bresch insisted there were other fees and costs that would cut revenue, but she didn’t clarify what those were or what the cost would be if customers bought one through their insurance plan.

In addition to the generic version and the assistance programs, Bresch touted her company’s public health campaigns to educate people about the need for epinephrine auto-injectors. She noted that many young children who suffer a life-threatening allergic reaction (anaphylaxis) do so without knowing in advance that they even had an allergy. Thus, it’s critical that schools and other public facilities always keep the devices on hand. She reported that since Mylan bought the EpiPen, the company has “now reached 80 percent more customers” and has given hundreds of thousands of pens away for free to public schools. She reported that the majority of individual customers pays less than $50 after discounts and health insurance coverage.

The committee didn’t buy it. “Don’t come in here and tell us that you’re doing the world a favor,” Rep. Earl “Buddy” Carter (R-Ga.) said. Carter, a pharmacist, recounted watching a mother break down in tears when he told her the price of her child’s EpiPen.

Several committee members said that many of their constituents were paying well over $50, which Bresch admitted was a growing problem. They also noted that a lot of costs not covered directly by consumers were simply passed on to health insurance companies, which in turn raise the price of their customers’ premiums.

“This is the same PR play book other companies used,” Cummings said of the assistance programs and discounts that Turing and other drug makers have unveiled. “Even with withering criticism and outcries,” he went on, these companies “never, ever, ever, never lowered their prices.” He openly worried that greedy pharmaceutical executives would continue to raise prices despite the occasional fussing from politicians.

“They’ll fly back to their mansions in their private jets and laugh all the way to the bank while our constituents suffer,” he said.

Shot of hope

Other committee members laid equal blame at the Food and Drug Administration for potentially holding up competitors’ auto-injectors with lengthy product approval processes. Also testifying before the committee on Wednesday was Doug Throckmorton, deputy director of the Center for Drug Evaluation and Research at the FDA. Throckmorton admitted that 2,300 products are now in line to get reviewed by the agency, but he noted commercial confidentiality laws kept him from revealing if any of those applications were for an auto-injector. However, Throckmorton noted that the agency has openly encouraged companies to submit an application for a generic or a competitor and would keep the approval process under 10 months for any that come in.

Meanwhile several pieces of legislation have been proposed to prevent or at least shed more light on the drug price increases. These include bipartisan legislation sponsored by US Senators John McCain (R-Ariz.) and Tammy Baldwin (D-Wisc.) released last week that would require drug makers to notify the government a month in advance of any price increases greater than 10 percent and to give a justification for the increase.