How One Pharmaceutical Company Priced Its Drug

I want to share with you the following WSJ article detailing how one major pharmaceutical company took advantage of the health care system to enrich itself, its shareholders and Wall Street with drug prices that produce “99% gross profit margins”.

I hope this will give you with some insight into the behind-the-scenes forces that are driving up health care costs.

How One Pharmaceutical Company Priced Its Drug

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

www.linkedin.com/in/philwlee   www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable

 

Wall Street Journal 5/2/2016:

Valeant’s CEO Was Key Force on Pricing

Documents collected during a Senate investigation provide look at how Valeant arrived at sharp price increases

Michael Pearson, chief executive officer of Valeant, lobbied for aggressive price increases on acquired drugs in recent years. PHOTO: DREW ANGERER/BLOOMBERG NEWS

By  JACQUIE MCNISH and LIZ HOFFMAN

Updated May 2, 2016 10:33 a.m. ET

​In early 2015, when Valeant Pharmaceuticals International Inc.’s top brass met to set prices on a soon-to-be-acquired cardiac drug, some executives suggested slow, staggered price increases. Chief Executive Michael Pearson disagreed.

To reach Valeant’s internal profit targets, Mr. Pearson lobbied for a single, sharp increase. Hospitals could still make a profit at the higher price, he argued, which meant patients would still have access to the drug. The team deferred. The day it completed its February 2015 purchase of the drug, called Nitropress, Valeant tripled the cost.

The exchange, recounted in a document reviewed by The Wall Street Journal, shows in greater detail than was previously known how Valeant and its now-outgoing CEO Mr. Pearson pursued quick, aggressive price increases on acquired drugs in recent years—a strategy that sparked widespread backlash and landed Mr. Pearson in front of a Senate investigative panel last week.

A spokeswoman for Valeant, Laurie Little, said, “We heard very clearly the concerns raised by the Senate Special Committee on Aging, and the board is working to map out a new path for the company going forward. That will include consideration both of how best to set drug prices and of the appropriate role of patient assistance programs in helping to ensure that patients can obtain the drugs that doctors prescribe for them.”

At last week’s Senate committee hearing Mr. Pearson said Valeant was “too aggressive” with drug price increases.

Dozens of documents collected during the Senate investigation provide a deeper look at how Valeant arrived at sharp price hikes on some of the drugs it sells. The documents underscore the challenges Valeant faces now that it has promised to roll back some prices and rely less on acquisitions for which price increases are a major driver. That pivot has investors and analysts concerned about where Valeant’s profits will come from and how it will service the $30 billion in debt it carries.

Related Video

Valeant CEO Michael Pearson testified at a Senate hearing investigating drug pricing Wednesday that he and the company made mistakes and “Valeant was too aggressive.” Watch an excerpt of his testimony. Photo: AP

Concerns over the company’s reliance on price increases, its accounting and other business practices hammered Valeant stock, which has fallen more than 85% since its high last summer. Valeant has said it is comfortable with its liquidity.

William Ackman, a major Valeant shareholder and recently appointed director, told the Senate committee that he and other new directors have “stabilized” a company that has made “significant mistakes.” The company’s stock has gone up about 27% over the past month as the company filed a long-overdue annual report, hired a new CEO and reached an agreement with lenders to avoid a technical default.

Under Mr. Pearson, a former McKinsey & Co. consultant, Valeant earned a loyal following on Wall Street for its profitable strategy of buying existing drugs with price-increase potential rather than developing them in-house. “Bet on management, not on science,” he often said. While Valeant did have a research program, Mr. Pearson said that most of Valeant’s R&D products are reformulations of existing drugs, such as a new delivery method for a glaucoma medicine, according to the Senate documents.

Valeant’s pattern of price increases, including on Nitropress, was the subject of a page-one story by the Journal last year. That strategy drew criticism amid broader political scrutiny of pharmaceutical costs. The Senate panel last week—the third in a series of hearings on drug pricing—focused on four Valeant drugs in particular, including Nitropress and Isuprel, which Valeant acquired from Marathon Pharmaceuticals in February 2015.

The other two drugs, Cuprimine and Syprine, are used to treat Wilson’s disease, a rare ailment involving a buildup of copper in the body, and were acquired by Valeant in 2013. Months after it raised the price of the cardiac-care drugs in 2015, Valeant sharply raised its price tags on Cuprimine and Syprine.

The price of Cuprimine has risen 5,787% to $26,189 since 2013, with most of the increase occurring in the summer of 2015, according to an analysis prepared by Senate committee staff for the hearing. The cost of Syprine jumped 2,934% to $19,783 during the same period. A doctor testified at last week’s Senate hearing that a liver transplant, an alternative treatment for Wilson’s disease, is now cheaper than a lifetime of Valeant drugs.

The Senate analysis referred to wholesale acquisition costs that hospitals and other purchasers pay for drugs.

Although the four drugs made up only a fraction of Valeant’s $10.3 billion in 2015 sales, they ranked among Valeant’s 30 most profitable drugs as measured by net profit, Valeant Chief Financial Officer Robert Rosiello told the Senate committee last month in a written response to questions.

So valuable were Syprine and Cuprimine that when a senior Valeant official learned that Valeant’s customer-service group lacked a way to log inquiries from patients complaining about their rising costs, he wrote in an email that “for these…drugs we need to find a way asap.” He inquired about purchasing software to track their complaints. “These patients are too valuable to lose,” Laizer Kornwasser a former Valeant executive vice president, wrote, according to the Senate hearing documents.

Mr. Kornwasser didn’t immediately respond to requests for comment.

At the 2015 meeting on Nitropress, which was attended by Valeant’s then-finance chief,Howard Schiller, Mr. Kornwasser and other top executives, some of the executives recommended gradual price increases to avoid alienating core hospital buyers of the drug, the Senate documents show. Mr. Pearson argued it wasn’t an “exorbitant” price for a drug that saved lives and represented only a fraction of hospital costs, according to the documents.

Upon completing its purchase of the two drugs in February, Valeant sharply raised the price of both Isuprel and Nitropress.

A month later, when a Deloitte consultant studied further price-tag spikes on the two drugs, the consultant asked a senior Valeant executive in an email: “Are you ok with the above assumptions? They are leading to high gross margins (more than 99%).”

The Valeant executive replied in an email that the analysis “looks right, and I’m not surprised they are extremely profitable.”

 

 

Obamacare: Enroll by Sunday 2/15 or Pay a Penalty

(Please disregard this if you have an Employer Group plan or have Medicare.)

For those of you who have not already enrolled into an Individual health plan, the enrollment deadline is this Sunday Feb. 15th.
After the Feb. 15th deadline, you will have to wait until the end of the year to enroll for Jan. 1, 2016. If you are uninsured, you may also face a penalty when you file your tax return in April 2016.

Possible Extension:
For those of you applying through Covered California for an On-Exchange health plan, if you start an online application before 2/15 but are not able to complete it on that day, we, as agents, have been given an extension to help you complete it, by 2/24. This extension is not available to the public and does not apply if you do not start an application by 2/15.
If you need help, please call us at 925-284-2000 or email [email protected] .

Phil Lee
Lee Health Insurance Services
925-284-2000
www.health-insurance.com

Avoid Penalty – Deadline Feb. 15th to Enroll into Individual Health Plan

Avoid Penalty – Deadline Feb. 15th to Enroll into Individual Health Plan

To avoid a penalty, the deadline to enroll into an individual health plan is Feb. 15th, 10 days from today. If you submit an online application by that date, you will be able to secure an Effective Date of March 1st. If you miss this deadline, you may not enroll again until the end of 2015.
This deadline does not apply to you if you experience a qualifying event during the year, such as a loss of Employer group coverage, a change in family status such as a marriage, divorce or newborn, a move out of the area, etc.
If you are uninsured, or insured only with a temporary or non-creditable health plan, you may face an IRS-assessed penalty for 2015 of up to 2% of your household income. (This is up from 1% in the 2014 tax year.)
If your estimated 2015 household (MAGI or Modified Adjusted Gross Income) is between 138% and 400% of the Federal Poverty Line (FPL, equivalent to roughly between $16,106 and $46,680 annual income for a single person household), you may apply to Covered California for an APTC (Advance Premium Tax Credit or Tax Subsidy) to help pay the monthly premium on a creditable health plan. If not, you may apply for an Off-Exchange health plan at the same price without a subsidy. We can help you with both. If you income is below 138% FPL (or your children below 200% FPL), then you may qualify for Medi-Cal (California’s Medicaid).
Please call us at 800-286-7445 if you need help.

Philip W Lee
Lee Health Insurance Services
Employee Benefits and Health Insurance
[email protected]
www.Health-Insurance.com

Alert to Individuals who Received Tax Subsidies or APTC to Pay for Covered California Health Plans – Form 1095A

(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)

Re: IRS Form 1095A and Form 8962

Covered California, the California health insurance exchange, will shortly be sending out a form called the IRS Form 1095A to all individuals and families who received tax subsidies in 2014 to help pay for their Individual/Family health plans. This is required by the federal ACA law (Obamacare) and will be sent out by Jan. 31st.
These forms will show, in detail, by month, the amount of APTC (Advance Premium Tax Credit or Tax Subsidy) that the recipient received in helping pay the premium for their subsidized health plans in 2014.
These individuals will be required to use this Form 1095-A to obtain information needed to complete Form 8962 (Premium Tax Credit (PTC)). They must then complete IRS Form 8962 and file it with their 2014 Tax Return by April 15.
Those who enrolled into Off-Exchange health plans need not be concerned, since they did not receive any tax credit, you will not receive a 1095A. Only those who applied for a health plan through Covered CA AND who received an APTC to reduce the premium paid, will be receiving these 1095A forms.
Those enrolled into Medi-Cal (California Medicaid), those on Medicare, and those enrolled on employer group plans are not affected by the above.

Disclaimer: We are not qualified to give tax advice. If you have any questions concerning either Form 1095A or Form 8962, please contact Covered CA, your tax adviser, the IRS or go to the IRS website links below:
www.irs.gov/uac/About-Form-1095-A
www.irs.gov/uac/About-Form-8962

Philip W Lee, MBA
Lee Health Insurance Services
www.health-insurance.com
800-286-7445

Update on Enrollment Deadlines: Extensions for OFF Exchange Plans

(Note: This alert relates only to Individual and Family health plans.  It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)

ON Exchange (Covered CA) plans:

As reported earlier, the 12/15/14 deadline has been extended to midnight Sunday 12/21/14.  Online applications only.  This applies to all Covered CA Exchange plans from Anthem Blue Cross, Blue Shield and Kaiser.

 

OFF Exchange plans (outside of Covered CA and direct with insurers):

Anthem:  The deadline has been extended to midnight Sunday 12/21/14.  Applications must be on paper.

Blue Shield: There are no extensions.  The deadline passed on 12/15.  (If you still want Blue Shield but do not need a subsidy, you may still apply through the Covered CA portal.  But you will still have to provide income and immigration status to the Govt.)

Cigna: The deadline has been extended to Friday 12/19/14 at 5 pm PST.

Health Net: The deadline has been extended to midnight Sunday 12/21.  Online applications only.  Applicants are encouraged to pay their initial premium by 1/1/2015, without waiting for their NOA (Notice of Acceptance).  You may use HN’s 24-hour payment line at 1-800-539-4193. You will hear the amount due as soon as HN has your enrollment in their system.

In all cases, the application extension plus the time required to process the files will impact timely receipt of the NOA (Notice of Acceptance) letters, initial premium bills, delivery of ID cards and policy descriptions.

If you need help, please call us at 925-284-2000 or email [email protected].

Phil Lee

www.health-insurance.com

800-286-7445

Last Minute Alert: Covered CA Deadline Extended to Dec. 21 for Individual Health Plan Enrollments

(Note: This alert relates only to Individual and Family health plans.  It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)

We just learned tonight that Covered CA, the State Health Exchange, has extended the previous deadline for Jan. 1 enrollments, from Monday Dec. 15th to Sunday Dec. 21st at midnight.  This extension applies only to Individual plans, and only to Consumer and Agent-assisted enrollments.

Covered CA also states that enrollments completed after Dec. 15th may see delays in invoicing as well as delays in proof of enrollment procedures.  To facilitate faster enrollment, they encourage submitting applications as soon as possible, but no later than Dec. 21st.

Please call us, Lee Health Insurance Services, at 925-284-2000, if we can be of assistance.

Phil

Philip W Lee MBA

Lee Health Insurance Services, BLIS Corporation

800-286-7445

www.health-insurance.com

www.yelp.com/biz/lee-insurance-services-lafayette-6

Tips on Applying to Covered California

Originally Posted on 3/25/2014
(This information relates only to Individual and Family health plans. Please ignore this email if you are on an Employer group plan, on Medicare or otherwise covered.)

Note: The last chance to apply for individual health insurance in 2014 is Monday March 31. However, based on our experience with past deadlines, Covered CA and possibly the insurance company websites may crash or be inaccessible on the last days. I highly urge you to apply before the end of Friday March 28th. If you miss the 3/31 deadline, you will have to wait until the end of the year to apply, and possibly pay a penalty.

Avoid these common mistakes on your Covered CA application:
• Designating an Agent — In order for us to help you during the enrollment process, and to troubleshoot problems, you must designate us as your agent on your online application. You do this by clicking “Finding Help Near You” on the upper right had corner of the screen. Please see screenshot instructions below:
https://www.dropbox.com/s/ckzl7m70h9brnt6/Agent%20Designation%20ScreenShots.docx
There is no cost to you to have an agent. And we provide free ongoing service and advice throughout the year.

• Remember your Username, Password and PIN — If you lose your login info, you will have to call Covered CA to reset them. Hold times may be as long as 3 hours, or not even be able to get through at all.

• Try to enter the correct information into the online application the first time around — some of the inputs are difficult to change unless you start a new application or call Covered CA (hold times may be as long as 3 hours.)

• Social Security Numbers — If you have already started an application with one (or one set of) Social Security Numbers, the system will not allow you to start a new application with any of those numbers.

• Withdrawing an application in order to restart a new one — it may take up to 2 weeks before you will be allowed to start a new one. By which time, you may be past the deadline.

• Entering the wrong income amounts into the online application — Before signing and submitting the application, be sure to check the income amounts carefully. If you submit an erroneous income amount, it may be difficult to change later without having to submit an Income Change, or withdrawing the application

• Household Members — Household members include dependents, but only those dependents who are claimed as dependents on your tax return. If they are adult children, or elderly parents who are not claimed as dependents on your tax return, they are not considered dependents.

• Household Income — You must include income from all household members who are considered part of your legal or tax household, even if they are not applying for coverage. You must carefully check the correct boxes or circles to indicate this on your online application.

• 3 Categories of Coverage Depending on Your Income — There are 3 categories. (1) If your HH income is below 138% of the Federal Poverty Line (FPL), (or for children, 250% of FPL), you will be automatically slotted into Medi-Cal (the CA version of the federal Medicaid or welfare program). As you know, very few providers accept Medi-Cal. (2) If your HH income is between 138% and 400% of FPL, then you are eligible to receive a subsidy (Advanced Premium Tax Credit) to help pay the monthly premium. Furthermore, if your income is between 138% and 250% of FPL, in addition to the subsidy, you will also be eligible to receive Govt. assistance for reduced Copays, Deductibles and Max. Out of Pocket costs. These plans go by names like Silver 77 or Silver 93. (3) The last category of Coverage is for those with HH income over 400% of FPL. For those in this category, there is no subsidy from the Govt. You may purchase any plan outside of the Covered CA Exchange. Although you may purchase these plans inside the CovCA Exchange as well, for full price, it is advisable to go outside the Exchange (using the links below) because: (a) You will not need to provide income, immigration, or other private information outside, (b) Your private data will not be shared with Govt. agencies like the IRS, Homeland Security, etc. and not submitted to Govt. databases for verification, (c) there are more plans and more carriers available outside than inside, (d) the online application process with the insurance carriers outside of the Exchange is faster, shorter and the websites function much more smoothly, (e) the prices are the same whether outside or inside the CovCA Exchange, it’s just that subsidies are not available outside.

Links to Apply to OFF Exchange (non-subsidized, non-CoveredCA) health plans:
Anthem Blue Cross: https://brokerportal.anthem.com/ehb/web/bkr/acc/agentconnect/PHILIPLEE_1
Blue Shield: https://www.blueshieldca.com/bsca/ApplyNow?xyz=I%2Bc68ZizpmLi
Health Net: https://www.healthnet.com/portal/consumer/ca/getYourQuote.ndo?region=CA&a=10952
Kaiser: https://smu.kaiserpermanente.org/expressweb/ClearWorkspace.action?nextAction=/user/URLDecryptAction.action&refID=7o830apvbn8eyriuut5qmukks0hfomvhibykqt7emn1yam3vpqwgnp5t815gww

How to apply to Covered CA and Outside marketplace:
https://www.dropbox.com/s/hqbjyqdxcecrs1j/How%20to%20Apply%20to%20CovCA%20or%20Outside2.docx

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
925-284-2000

Update of Obamacare Deadlines

Originally Posted 1/15/2014

(This information applies only to Individual and Family health plans. It does not apply to Employer Group plans or to Medicare plans.)

Covered California Payment Deadlines:
For those of you who applied for Individual/Family coverage with an Effective Date of Jan. 1st., either On Exchange (Covered CA), or Off Exchange (from the insurance carrier). Some of the deadlines for initial premium payments have been extended. Those deadlines are:
Blue Shield, Jan. 15th
Health Net, Jan. 15th
Anthem Blue Cross, Jan. 31st
Kaiser, Jan. 31st
Open Enrollment Period Continues
If 1) your plan was cancelled, or
2) you were mapped to a new plan by your insurance carrier, or
3) you opted for an extension to March, or
4) you are on a grandfathered plan, or
5) you are simply uninsured
You may still apply to a new or change insurance carriers before March 31st.
Open Enrollment Application Deadlines:
For Feb. 1st start dates, the deadline is Jan. 15th.
For March 1st start date, the deadline is Feb. 15th.
For April 1st start date, the deadline is March 15th.
For May 1st start date, the deadline is March 31st.
Last day of Open Enrollment for 2014 is March 31st.

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
www.HealthPlanTalk.com
925-284-2000

Follow

Get every new post on this blog delivered to your Inbox.

Join other followers:

Contact us for the best healthcare insurance for individuals, families, business groups and seniors.



Lee Health Insurance Services | Healthcare Insurance Agency, Individual Health Insurance, Family Health Plans, Group Medical Insurance, Small Business Health Insurance, Whole & Term Life Insurance, Dental Insurance, Health Care Reform Assistance, Covered California Insurance Exchange Plans, Medicare Supplement Insurance, Medicare Advantage, Medigap Plans, Anthem Blue Cross, Kaiser Permanente, Blue Shield of CA, Health Net, Cigna, Aetna, Contra Costa County CA, Pleasant Hill, Danville, Concord, Berkeley, Martinez, Albany, Oakland, San Ramon, Alameda, Santa Clara, Campbell, Milpitas, Cupertino, Sunnyvale, Saratoga, Fremont, Palo Alto, Newark | 935 Moraga Road, Suite 240, Lafayette CA 94549 (925) 284-2000 or Toll-Free, (800) 286-7445