Yes, there is more than supply and demand going on here, which explains why one company's pricing policies can't account for a 500% industry-wide increase. Novo is not a monopolist.

A lot has changed in the last 20 years. A lot of regulatory and insurance law changes. When the law mandates that we pay for all our medicine via 3rd party intermediaries, you can expect a corresponding price increase as those 3rd parties add their intermediary markup.