THE CAUSE OF MASSIVE U.S. INSULIN PRICES: “FEES” FROM PHARMA PAID TO THEIR LARGE HEALTH INSURER/PBM PARTNERS, DIRECTLY TIED TO MASSIVE “STICKER” PRICE INCREASES

Health insurer/PBM Lobbyist (PCMA) report, May 2018 : https://www.pcmanet.org/wp-content/uploads/2018/05/Insulins-Prices-Rebates-Costs.pdf

Quotes directly from the PCMA Report:

“Insulin prices have increased more than 10-fold since 1985. Prices have escalated more dramatically during the past 10 years.”

“During the past 10 years, gross sales for insulins have increased significantly due entirely to price increases, while overall utilization/prescription volume has remained flat.”

“During the past 20 years, new insulin competitors have entered the market, but always at higher prices than the existing market.”

“Top insulin brands: no correlation between rebates and price increases”

“Top insulins with lower average rebates have actually had higher annual price growth during the 2011-2016 period.”

So, the basic laws of supply and demand for insulin, and lots of other U.S. brand drugs, have turned upside down? – really?

10-fold UNIFORM U.S. insulin price increases when demand is stagnant overall and use of many of the old insulins is plummeting?  – really?

New insulins, without any major medical advantages, are launched at even HIGHER prices and sell very well controlled by formularies of the dominant health insurer/PBM formularies? United Health, CVS/Aetna, Cigna/Express Scripts, Humana control 80-90% of U.S patients/plans. – really?

And, of course, the insulins with LOWER rebates (i.e., discounts for patients)  have HIGHER price increases and still sell very well controlled by the few dominant health insurer/PBMs. – really?

PHARMA FEES, NOT REBATES!/PHARMA FEES, NOT REBATES!/PHARM FEES NOT REBATES!

PHARMA AND DOMINANT HEALTH INSURERS/PBMs – PARTNERS, NOT ENEMIES!

PHARMA AND DOMINANT HEALTH INSURERS/PBMs – PARTNERS, NOT ENEMIES!

Of course, none of these ridiculous U.S. insulin market dynamics are remotely a surprise when you factor in the simple, but secret way these dominant health insurer/PBMs are really making money in the U.S insulin market – which of course is not mentioned in the PCMA report.

By secret “FEES” (not illusory REBATES) from their insulin manufacturer PARTNERS, standardly tied directly to massive “STICKER” price increases in national contracts. Other than rebates, these pharma fees are the ONLY way for these health insurer/PBMs to be making the big money driving their surging brand drug profits.

The dominant health insurer/PBMs have standardly been getting a “percent” of each and every price increase put through by the insulin manufacturers over the past 10-15 years, with the higher drug costs passed on to us. That is it. No other reason.

You see – BOTH pharma and the dominant health insurer/PBMs are managing ALL insulin prices UP at the same time to maximize their profits at our expense. Their is no real price competition. Same thing going on in the multiple sclerosis, rheumatoid arthritis, cancer and other big U.S. brand drug markets.

The scheme started with Medicare Part D (into law 2003, started 2006) when the dominant health insurer/PBMs were given control of the program, with pharma’s support. All three of the largest PBMs were OWNED by pharmaceutical companies just before Part D passed into law. No coincidence that insulin prices (like most old brand drugs) were the same price in the U.S. and Europe just before Part D. Get the picture. Not complicated. Just depends up fiercely guarding secrets, creating distraction and of course throwing money everywhere.

All the other spin out there from pharma, their dominant health insurer/PBM partners and their lobbying groups/consultants (rebates, complexity, endless finger-pointing in a lot of directions, etc.)  is just nonsense to distract and keep the secret fee game going.

Take it from a physician, MBA and an honest professional healthcare investment analyst who has been following/meeting with these companies and their senior managements for three decades.

And how am I certain this SIMPLE FEE scheme is TRUE?

Lots of reasons, but most importantly because I went to an industry conference 6+years ago now where 50-60 pharma and health insurer/PBM executive insiders and their close confidants/consultants discussed it openly…

And guess what – executives from two of the three big insulin manufacturers – Sanofi and Novo Nordisk were at this conference, along with executives from other drug/biotechnology companies that have generated big revenues through massive price increases on their major U.S brand drugs over the past decade, including, AbbVie (Humira), Pfizer (Lyrica, Viagra, Premarin, Celebrex, etc.), Amgen (Enbrel) and Mylan (Epipen). Again, no coincidence.

Read all about the October 2013 conference, and more clear evidence of the fee scheme, here in the link to the DEFINITIVE PROOF section (https://drugpricetruth.org/evidence/)of the website, www.drugpricetruth.com.

All the information on the website is PUBLIC  from my extensive qui tam Whistleblower case documents provided under the CASE DOCUMENTS section (https://drugpricetruth.org/case-documents/) of the site.

SADLY, THE PRICES OF ALL INSULINS IN THE U.S. HAVE DOUBLED AGAIN SINCE I WENT TO THAT SHOCKING MEETING IN OCTOBER 2013 AND FILED MY FIRST WHISTLEBLOWER CASE JUST A FEW MONTHS LATER, IN THE PUBLIC INTEREST.

I hope I can eventually get some of you out there to help stop it.

The ongoing harm to diabetics across this nation is horrific and is only going to get worse until this simple, but secretive scheme is addressed. How many more stories about parents losing children or people travelling to Mexico and Canada do we need to read?

“PEOPLE BEFORE PROFITS”

To win a battle, you need to know the truth and who the enemy really is. Just follow the money.

I would be glad to speak to anyone interested. I can be contacted easily by email at info@drugpricetruth.org

John R. Borzilleri, M.D.

Leave a Comment

Your email address will not be published.

Scroll to Top