Follow the Money:
A Simple Scheme, Massive Harm

STRAIGHTFORWARD QUESTIONS AND ANSWERS:

QUESTION #1:

• WHO has been making most of the money from massive U.S. brand drug price increases over the past decade-plus ?

ANSWER #1:

•  BOTH biopharmaceutical companies AND the dominant health insurer/pharmacy benefit managers (PBMs)
  • Vast revenue and profit growth for BOTH
  • Vast stock price increases for BOTH
  • Massive senior executive compensation for BOTH

• PHARMA AND THE DOMINANT HEALTH INSURER/PBMS ARE PRETENDING TO BE ENEMIES WHEN THEY HAVE ACTUALLY BEEN CLOSE PARTNERS IN RAISING U.S. DRUG PRICES FOR THE PAST 15 YEARS

QUESTION #2:

WHEN did it start?

ANSWER #2:

•  SUDDENLY, when Medicare Part D began: 2003-2006
  •  First ever and essential U.S. senior outpatient drug benefit
  •  80-90% of Part D controlled by the four dominant U.S. health insurer/PBMs:
    • United Health, CVS/Aetna, Cigna/Express Scripts, Humana
  • The top PBMs were OWNED by pharmaceutical companies just before Medicare Part D
• U.S. & Europe brand drug prices were the SAME when Part D began in 2006
  • • Americans now often pay 8-10 times more
    • NO PBMs outside of the United States
    • Link to chart of U.S. vs. European multiple sclerosis drug prices

QUESTION #3:

HOW are the pharma and health insurer/PBM partners massively raising U.S. drug prices TOGETHER?

ANSWER #3:

• The pharma companies are making secret "fee" payments to the dominant health insurer/PBMs DIRECTLY TIED to massive U.S. brand drug “STICKER” prices
  • In secret contracts, pharma is paying health insurer/PBMs a "PERCENTAGE" of massive U.S. "STICKER" price increases for many brand drugs in sharply declining use by physicians and patients
  • Huge increase in profits for BOTH pharma and health insurer/PBMs
    • Pharma getting massive profits for selling LESS of a brand drug
    • Health insurer/PBMs getting massive profits from "pharma fees" often for doing LESS work to support patients
    • Accelerating drug costs passed on to patients, families, businesses and taxpayers 

• Began with a secret “pharma fee” loophole in Medicare Part D
  • "Pharma fees" tied to STICKER prices  now secretly account for MOST health insurer/PBM profits from U.S. brand drugs

• Now an ever-worsening national crisis
  • The scheme now systemic across U.S. health insurance markets
  • Widespread massive 5-to-10-fold or more U.S. brand drug price increases over the past decade-plus
  • Severe patient, family, business and taxpayer harm
    • $175+ billion just for the 22 major U.S. brand drugs in my two whistleblower cases
    • Whistleblower cases include: AbbVie's Humira and Amgen's Enbrel (autoimmune), Sanofi's Lantus and Eli Lilly's Humulin (insulins). Novartis' Gleevec (cancer) and Pfizer's Lyrica (seizures, diabetic pain).