Pharma/Health Insurer/PBM Price Collusion: More than a decade of severe patient harm and a huge missed drug savings opportunity for all Americans.

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 years where it remains now. The only way for both pharma and the health insurer/PBMs to avoid plummeting revenues and profits (and stock prices) was to enter into the secret “fee” scheme to massively raise the U.S. prices on the few remaining brands, which was the starting point for even higher abusive prices for new drugs reaching the market.

On a personal level, the harm over the past decade has been most devastating for diabetic, cancer, MS, rheumatoid arthritis and many other severely ill Americans as they struggle to afford the skyrocketing costs for essential life-saving drugs.

But we are all in this together and we are all paying for the massive increases in U.S. drug costs.
Virtually no one can afford the now routine $70,000-$500,000+ annual cost for drugs for severe conditions. We are all paying for it as taxpayers in Medicare Part D and in our ever-rising private insurance health plan premiums, co-pays, co-insurance, deductibles, etc.  

And we are all just one diagnosis away from facing the potential financial crisis that our most vulnerable friends and families are now dealing with daily. Just imagine a being a person/family with limited (or not so limited) financial means faced with covering a $10,000-30,000 share of a $200,000+ cancer drug. Of course, this drug bill could be on top of a share of an endless number of big hospital and other medical bills while facing tremendous duress from the illness itself. Seems unimaginable until it suddenly happens to you or someone close to you.  

And this U.S drug pricing crisis should never have happened. Driven by this abusive scheme, drug spending has been the fasting growing part of skyrocketing U.S. healthcare costs than now consumes nearly 20% of our economy, double almost every other major country.

In a legitimate competitive U.S. pharmaceutical market, with widespread U.S. brand drug patent losses, all Americans would have benefited over the past decade-plus from a sharp DECLINE in drug costs. By my estimates, drug costs in the U.S could have decreased 40-50% for the nation over the decade in both Medicare Part D and in private insurance plans.

Link to the brief discussion of the huge missed drug savings opportunity in Medicare D, from the whistleblower Court documents:  /wp-content/uploads/2020/02/PartDSavings22120.pdf

Think of how all these excessive U.S. drug costs could have been better used over the past 15 years? More jobs from both small and large employers across the nation?; higher pay for employees?; healthcare coverage for many uninsured people?; education?; and many other possibilities.

The information in this blog post and on the website is all public. It is either discussed in detail in the whistleblower Court documents found on the website or in other public venues.  I stand by the accuracy of the whistleblower filings and am not aware that any substantive  information has been factually refuted.

I would greatly appreciate your sharing this blog post and the website. Thanks for your interest.  

I would be glad to speak with any interested party. I can be easily reached by email at

John R. Borzilleri, M.D.

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