[gizmo]

The that only insurance companies felt the price is an audacious lie by Shkreli and his people. Documents that were subpoenaed for the congress hearing revealed that people with insurance got stuck with 30%-50% co-pays. At 75.000 a bottle a 40% co-pay is still a 30.000 out of pocket expense. Regular people have to remortgage their house to come up with this kind of money.

Shkreli basically lied about everything. He lied about his business model. He lied about the availability of the drugs. He lied about his programs that supposedly made the drug available to people who could not otherwise afford it. The guy is a real piece of work.

Watch the hearing on C-SPAN if you don't believe me.

http://www.c-span.org/video/?404183-1/hearing-prescription-d... http://www.c-span.org/video/?406885-1/sudden-price-spikes-de...

Found the timestamp, starts at 00:41:00 (second hearing) where victims of Martin Shkreli talks about their attempts to mortgage their house in order to pay for the drug for their sick child.

[MichaelGG]

Is he lying about doing drug research? He says no one else was doing anything for this disease as it is so rare. Seeing how old the drug is and no one else is even making it seems to prove that part of the claim.

Are there proofs of the availability program but working outside this video? Seems like news people should document such cases and bring them up. Even better if they'd do so live on his webcam.

[gizmo]

What he called drug research was in reality drug acquisition/market research. His spiel about his intention to do real research to improve abandoned drugs is intentionally unfalsifiable because it's about FUTURE research he promises to do, you know, some years down the road. We're supposed to take his word for it and meanwhile he makes his billions.

The reality is that all the executives at Turing were his hedge fund buddies, the investors were other hedge fund buddies and Shkreli made nearly a billion dollars in 3 years with his price-hiking shenanigans. In investor presentations he doesn't even refer to Turing as a pharma business nor does he talk about his planned pharmaceutical research, he presented the business as a pharma-hedgefund-hybrid: an easy way to make boatloads of money.

This isn't what you'd expect to see from somebody who is passionate about drug research and curing kids, this is what you expect to see from somebody who cynically exploits a system. That internal correspondence (again, subpoenaed) shows they're like "lol, sucker" whenever an individual pays the list price for their drugs makes it crystal clear how concerned they are about providing a service to humanity.

See e.g. http://democrats.oversight.house.gov/sites/democrats.oversig... for some nice quotes

[ZenoArrow]

> "Is he lying about doing drug research?"

I would say so, yes. Note how none of the products that they're supposedly developing are in clinical trials, despite being Turing Pharmaceuticals indicating they should be...

http://www.forbes.com/sites/johnlamattina/2015/12/15/martin-...

[thucydides]

Where's your evidence for these high co-pays that Turing did not subsidize? I searched both transcripts for "co-pay" and "mortgage," and didn't find anything like what you're claiming. In fact, I see the opposite. I see the CEO of Turing being cross-examined by a hostile Massachusetts congressman accusing her of causing $6000 co-pays. She says, no, we paid anyone directly who fell through the cracks in this way. He replies, "after 4 days."

Searching for the word "mortgage" yielded no results for me.

I used to think drug companies were a scourge. After researching the Shkreli controversy last year I'm not so sure. But Shkreli, with his (often funny) dickhead antics, certainly would be a convenient whipping boy -- if anyone, like Congress or special interests -- needed a whipping boy to distract the public from what's actually ailing American health care.

For some perspective, drugs are only 1/10 of American health care costs.

  Prescription drugs: 10%
  Dental care: 4%
  Hospital care: 32%
  Physician/clinical services: 20%
  
  Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/PieChartSourcesExpenditures2014.pdf

And as far as Shkreli goes, the reality, as far as I've seen so far, is that no one is paying these sky-high prices for Daraprim out of pocket. Check out Turing's 10-K's; they reinvest their profits in R+D. Shkreli himself seems to be legitimately interested in developing new and better treatments for rare diseases. (CMD+F: "PKAN" on this page: http://www.bloomberg.com/news/articles/2014-04-17/retrophins...)

Serious question. For these super-rare diseases like toxoplasmosis, the current profit model is this. First, charge a high price ($30k-$100k) for a course of treatment. Then, the few people suffering from the rare disease get the drug via insurance. Does anyone have a better way of incentivizing drug companies to create new treatments, or better treatments, for rare diseases?

[gizmo]

The evidence is in the hearings, just watch them. The transcript search doesn't work for me (paywalled).

Also see page 4 of this document (which I already linked to):

http://democrats.oversight.house.gov/sites/democrats.oversig...

And in the congressional hearing there was one family facing a $350,000 price tag for their Daraprim cure which insurance refused to cover altogether because of the price hike, and Turing refused to help. The family did eventually get the medicine they needed, but Turing left them out to dry.

I'm fully aware Turing states "nobody falls through the cracks", but it's a blatant and audacious lie and there are dozens of experts testifying as much. You'll also find expert testimony in the linked videos. Many hospitals stock one or two bottles of Daraprim so they can immediately help walk-in patients. So now when somebody can't get Daraprim through insurance the doctors beg nearby hospitals to fedex the pills they have in stock from before the price hike. This supply is quickly running out.

The sales volume of Daraprim dropped by 80% or so as a result of the price increase, and the Turing executives state that thanks to their actions availability of the drug has broadened. A clear contradiction. Less volume means sick folks simple have to go without, which can have very serious health consequences.

Heck, even the Massachusetts General Hospital stated, and I quote!

    This is a critical matter, visible at the highest levels of our
    Infectious Disease Department [...] Daraprim’s new price on their
    inpatient pharmacy budget, which they have determined to be
    prohibitively expensive. Against their clinical convictions
    they are currently switching patients to Bactrim.

Observe that patients who are now forced to use the inferior Bactrim do not deal with Turing at all, which means there is no application for Turing to reject. Translated into Turing's bizarro PR language: "nobody falls through the cracks". In the real world we understand that people not getting the medicine they need is a problem.

Watch the hearing videos (especially the Subcommitte on Aging one). Read the actual filings and other primary sources, not the PR spin.

[thucydides]

Again, you make two claims here. 1: co-pays for Daraprim are very high. 2. Turing does not reimburse for those high co-pays.

You're right about number 1.

You cite no evidence for number 2. For its part, Turing says they reimburse for the high co-pays. Why wouldn't they? It would be a PR disaster not to reimburse, so it's manifestly in their interest. And they're making such a fat profit they can afford to reimburse people for high co-pays.

Page 4 of the document you cited is just a list of examples of high co-pays. Yes.

Again, where's the evidence that Turing does NOT reimburse for those co-pays? Do you have an example?

[gizmo]

The evidence is right there in the PDF as well as in the C-SPAN videos I linked. I'm not going through 8 hours of video I watched several months ago to find the exact timestamp, but since you claimed you researched all this you must have watched the videos with all the damning testimony they contain already. It's pretty clear at this point you refuse to acknowledge any evidence that makes saint Shkreli look bad so there's no point in going back and forth any further.

From the memo I linked earlier:

> The email stated that the first patient “has a $6000.00 co-pay. She is not a Medicare part D but has a federal funded insurance plan so wouldn’t quali[f]y for co-pay assistance or be covered under whatever Medicare Part D plan you are working on right now with Turing.” The email stated that the second patient “has insurance, however her plan does not cover Daraprim. Attempted to transfer to UCB for free drug program but was advised that because she has insurance, she does not qualify. Free drug program is only for patients with no insurance.”

Basically, Turing says "sorry, you don't qualify". Turing denies people's claims repeatedly, because they just don't give a fuck. Not to mention the obvious problem of patients not being able to afford the co-pay, thereby having to go without the pills. I've clearly demonstrated that there are cases where patients cannot get the medicine they need as a direct consequence of the price hike. But hey, feel free to believe Turing is acting honorably because they want to protect their reputation. Believe whatever you want. I'm done here.

https://i.imgur.com/XBsKiFx.png

[thucydides]

I don't have a horse in the race. I just think you're not reading these documents carefully or considering the evidence carefully.

For example, that case you cite above, the $6k copay. OK. Read the memo closely. A Walgreens exec is emailing a Turing exec citing a patient's problem with Turing's bureaucracy.

How was the problem resolved? Did Turing pay? You say that CLEARLY Turing didn't end up paying in this particular case, because you hate Turing, but the document doesn't say. And you have no idea. Neither do I, but I'm not pretending.

Generally: Turing says, for goodwill, they give away 60% of the drug for a dollar.

Do you know of even one case where someone - verifiably - fell through the cracks and Turing refused to EVER pay?

Are you opposed to the idea of pharmaceutical companies selling orphan drugs at high prices ($100k, $300k, or more)? Or are you only opposed to Turing's purchase of Daraprim and raising the price? Would you still oppose them if, in 10 years, it turned out Turing's profits had, e.g., produced a PKAN drug? Do you know a better way than high drug prices to incentivize the creation of drugs for serious rare diseases?

[koolba]

So who's the real crook?

Is it the sleazebag who legally takes advantage of the terrible system that we refer to as the US health insurance system?

Or is it the 435 representatives and 100 senators who are in the pockets of the insurance companies and pharma companies that perpetuate our current system?

At a moral level, yes the guy is as bad as they come (and those youtube videos of him are just plain weird). But I'd argue he's not the cause of our problems, he's a product of the system that we've cornered ourselves into.

[gizmo]

He's a real crook in a system that's awful. It's not either-or in my book.

So I agree he's not the root cause. He just pushes the existing framework to its "logical" conclusion. But only if "Logical" means being as ruthlessly exploitative as possible. Even the other sleazebag drug CEOs don't go this far, so Shkreli is uniquely contemptible.

But yes, ideally anger should be directed to the pharma industry and health insurance as a whole, not to Shkreli the individual.

[koolba]

> He's a real crook in a system that's awful. It's not either-or in my book.

The "either-or" is figuring out which one to go after and where to change things. If you only go after the Shkrelis, it's all for show and probably is a waste of tax payer money as he'll get off the hook for not legally doing anything wrong. People need to wake up and go after the real problem and replace the healthcare system and corrupt officials that perpetuate it.

[ZenoArrow]

Why do you only have to go after one side? Both sides (the corruptor and the corrupted) can and should be held accountable. Holding Shkreli accountable is more than just a token gesture, and no charges would've been brought against him if no laws were broken.

[koolba]

I fail to see what laws he's broken. If you're going to allow a "free market" healthcare industry, this is the result. Being a dick isn't a crime. Neither is being a price gouger.

[ZenoArrow]

> "I fail to see what laws he's broken."

Take a look then...

http://www.marketwatch.com/story/these-are-the-charges-again...

[unfamiliar]

Exactly. This guy is such a smug bastard that he makes the perfect lightning rod for the whole country to direct their rage at, deflecting it away from the actual system that allows this to happen.

[adrenalinelol]

While I detest what he did, it's no different than what any other free-market minded individual would do. Our healthcare system is a profit motivated, not patient motivated. He put profits over people, just like every other big phamrma company. He also was a publicity seeking douchebag, so the media had a field day with him.

[ZenoArrow]

In terms of fairness, it's only unfair if we hold some people in the industry to moral standards we don't apply to others. Our choices to maintain fairness are either to hold all economic actors accountable for their actions, or to hold none of the economic actors accountable for their actions. You seem to favour the latter, I favour the former, neither of us is wrong in terms of fairness.