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The simple corporate scheme behind massive US Brand Drug Prices

My 7-year whistleblower effort
"People Before Profits"

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

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).

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