Last week, all the Health Insurer/PBM CEO Schemers appeared at the White House for a worthless photo opportunity. You can see the video at this link: https://m.youtube.com/watch?v=CYdEUZZkDNI As they always do, these Health insurer/PBM CEOs talked in rosy platitudes about how patients and the American public  are always their main concern. I have been hearing that spin for decades now. Please. You don’t have to be familiar with the disturbing stuff on this website to know that these CEO claims are almost pure BS. Their true “mission” is always profits and massive executive compensation packages, while spouting glossy nonsense and […]

“PBMs don’t make their money off of rebates anymore”. “PBMs make their money off of service fees”  – these PBM “fees” come from drug companies as a “percent” of brand drug “sticker” or “list” prices. “You just have to play ball with them (PBMs)” to get a contract. These were some of the firsthand statements casually stated to me at a private investor meeting in the fall of 2014 by the CEO of a mid-sized pharmaceutical company, Depomed. The former CEO of Depomed is a nice gentleman that I have known for more than 20 years and had met with […]

In mid-2013, through investigation using my training as a physician and an experienced healthcare investment professional, I uncovered the remarkably simple and secretive pharma/health insurer/PBM price collusion “fee” scheme behind widespread massive U.S. brand drug prices over the past 15 years. There is no other explanation for massive U.S. brand drug price increases. That was true in 2013 and is more so now as the irrefutable evidence has mounted and patient/public harm has greatly accelerated. However, even with the extensive investigative evidence, I filed my whistleblower cases for a very specific reason – because “insiders” admitted the whole thing to […]

August 2018 should have been the end of the U.S. PBM industry as we know it, but nothing happened. Under intensive scrutiny about drug pricing, within a couple of days of each other that month, the senior managements of both CVS and Express Scripts made cataclysmic public admissions for the first time in their quarterly conference calls with expert Wall Street analysts. Both CVS and Express Scripts publicly admitted for the first that less than 10% of their skyrocketing profits now come from keeping a share of manufacturer rebates (i.e., discounts negotiated for clients and patients). As a physician and […]

There is only one explanation – A massive increase in secret “fees” from their drug company collusion “partners”, directly tied to skyrocketing U.S. brand drug prices/price increases, FOR DOING FAR LESS WORK. Below are the shocking financial numbers for the top pharmacy benefit manager (PBM), Express Scripts, from their own financial statements on file with the Securities and Exchange Commission (SEC). Express Scripts is now part of Cigna, after more mergers (including CVS/Aetna)  that only worsen the public harm, while serving to increase the secrecy of the ongoing simple pharma/health insurer/PBM “fee” price collusion scheme. Remember, pharmacy benefit manager (PBM) […]

Across this nation, the dominant health insurer/PBMs are forcing patients and families to use their in-house mail order pharmacies for almost all chronic therapies. The dominant health insurer/PBMs (UnitedHealth, CVS/Aeta, Cigna/Express Scripts and Humana) are routinely blocking patients from getting their prescriptions filled at local independent pharmacies, many of which have been serving their communities for generations. In fact, in recent communications CVS has been informing patients that their chronic medications will not be covered at all if they don’t use CVS’ mail order pharmacy. The health insurer/PBMs claim they are only forcing mail order to lower costs and improve […]

As per my last blog post, the two main drivers of this remarkably simple “fee” price collusive partnership were: Medicare Part D: With taxpayers paying for massive price increases in the new program when our senior citizens were given much needed outpatient drug coverage for the first time in 2006. Medicare Part D has been the largest revenue and profit driver for both the pharma and health insurer/PBM market over the past decade-plus. Massive U.S brand drug patent losses: In the U.S., brand drug Rx volume fell from 50% of the market to less than 10% in only a few […]

I cannot overstate the remarkable simplicity of the scheme behind systemic massive U.S. brand drug price increases across this nation over the past 15 years. The vast patient and public harm has been caused by a simple, but seismic change in the way that pharmaceutical companies pay the handful of dominant health insurer/PBMs (UnitedHealth, CVS/Aetna, Cigna/Express Scripts and Humana) that control 80-90% of drug benefits in this country. Before Part D: Virtually ALL health insurer/PBM brand drug profits came by secretly keeping most of the rebates (i.e., discounts) negotiated with pharma companies that they were supposed to pass on to […]

Six Facts in Plain Sight Virtually ALL brand drug profits for the four dominant health insurer/PBMs (United Health Care, CVS/Aetna, Humana) have secretly come from the pharmaceutical industry for the past 20+ years. Before Part D, the profits came from secretly keeping most pharma rebates/discounts that should have gone to patients and clients. Now their profits come from keeping virtually all “fees” from secret national contracts as a percentage of massive U.S. brand drug prices and price increases. All the public rebate talk now is just nonsense and a diversion tactic. The three largest PBMs were OWNED by pharmaceutical companies […]

The largest healthcare whistleblower cases in history by a wide margin – yet the silence remains deafening. $175 Billion and growing every day. The scale of harm sounds ridiculous, but it is not – it has been driven by massive 5-10-fold U.S. price increases over more than a decade for 22 blockbuster brand drugs. Just look at the picture links on the website or in the whistleblower complaints. Truly shocking. The two whistleblower cases target the simple systemic “fee” scheme behind one of the greatest healthcare crises to afflict this nation in the past several decades – the widespread increase […]