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The simple corporate scheme behind massive US Brand Drug Prices

My 7-year whistleblower effort
"People Before Profits"

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About John R. Borzilleri, M.D.

I am a physician MBA, who has been a healthcare investment professional for nearly thirty years. I have a degree in Biology from Brown University (1981), a Medical Degree (M.D.) from New York University School of Medicine (1985) and a Masters in Business Administration (MBA) from Columbia University (1991).

In the course of my work as a physician and an ethical investment analyst, I discovered some disturbing and inexplicable US brand drug pricing trends in late 2012.

I noted an array of “old” US blockbuster brand drugs, especially in the multiple sclerosis and other large categories, in which the biopharmaceutical companies were reporting  massive U.S. sales growth driven only by severe price increases, while use of the drugs by doctors and patients was sharply declining due to severe competition.  

These massive anti-competitive brand drug price increases were only occurring in the United States. It made no competitive sense, so I began investigating.

Over the next year, I uncovered the secretive “pharma fee” price collusion scheme  between pharmaceutical companies and the dominant health insurer/pharmacy benefit managers (PBMs) at the center of the pricing abuse.

The scheme has its origins in the Medicare Part D program.

In October 2013, I verified the harmful systemic scheme with extensive firsthand admissions from directly-involved industry insiders.

About the Whistleblower Lawsuits

In January 2014, I filed the first of two False Claims Act (FCA, qui tam) whistleblower cases , in the public interest, seeking to stop escalating patient and taxpayer harm directly caused by this ongoing corporate price collusion scheme. This initial FCA case targeted massive 8-to-10-fold systemic price increases in the U.S. multiple sclerosis market, from $15,000 patient/year when Part D began to the $100,000 range now. This case alleges taxpayer harm in excess of $60 billion in the 15 years since Medicare Part D began.
Link to the Whistleblower FCA Amended Complaint regarding the U.S. multiple sclerosis market, filed in the District Court of Rhode Island in August 2018

In October 2015, with public harm accelerating from widespread escalating U.S. price increases, I filed a second FCA whistleblower case targeting severe 5-to-7-fold price increases in the U.S. insulin, cancer, rheumatoid arthritis and other brand drug markets. This case estimates taxpayer harm in excess of $115 billion in the 15 years since Medicare Part D began.
Link to the Whistleblower Amended Complaint regarding the U.S. insulin, cancer, rheumatoid arthritis and other brand drugs, filed in the Southern District of New York (SDNY) in August 2018

Unfortunately, the Department of Justice (DOJ) failed to properly investigate these FCA actions by not pursuing major allegations/evidence and first hand insider witnesses provided in the FCA legal documents.
Link to my Court affidavit, filed under oath, discussing DOJ's first hand admissions of investigative failure in these FCA actions

At the eleventh hour, DOJ then blocked my lawyer and I from pursuing these FCA cases on our own, in the public interest, despite escalating evidence and harm.

Both District Court decisions are now in the process of being appealed with higher Courts.

Courthouse

Mission

“PEOPLE BEFORE PROFITS”

To inform and hopefully engage the American public regarding the straightforward, but highly secretive, corporate price collusion scheme behind massive U.S. brand drug price increases over the past 15 years.

To inform the public regarding my 7+ year effort as a federal whistleblower to stop the ongoing and escalating drug pricing abuse which began with the Medicare Part D program.

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