Follow the Money:
A Simple Scheme, Massive Harm
The Secret Pharma & Health Insurer/PBM "Partners" in Massively Raising U.S. Brand Drug Prices
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
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- 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
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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).