Meet Martin – The Martyr

Poor Martin Shkreli.

His last name aside (and I thought mine was bad), the former CEO of Turing Pharmaceuticals just cannot catch a break.

These days everyone it seems – HIV patients, politicians, even a group of witches – have his picture on their dartboards.

Journalists especially have had a field day with his sensational decision to jack up the price of Turing’s drug Daraprim by almost 4,500%: “His aim…was to exploit an existing monopoly and make millions before competitors could enter the market.”

Ok, and your point is? I mean, what kind of CEO wouldn’t want to capitalize on their unique position in the marketplace?

A CEO at risk of putting their company out of business. That’s who.

Not so with Martin though, who celebrated hiking the price of Daraprim from $1,700 to $75,000 a bottle by emailing a fellow Turing executive “$1bn here we come.”

And as brash as he might be brainy, as soon as the media fixed its gaze on Martin he really started strutting his stuff. To the point that now, having been as thoroughly vetted as any Presidential candidate, the resulting glimpse into the life of this American drug company lord never fails to disappoint.

A white and nerdy man who claims he’s a part of hiphop culture because he grew up “on the edge of the hood.” Who paid $2 million for the most expensive album in history, then threatened to destroy it. Who refused to cooperate when hauled before a congressional oversight committee, then tweeted how the congressmen who questioned him are all imbeciles – as he almost got into the wrong SUV.

Martin’s stress level must be through the roof. As well it should be. I mean, after all the insight into his character it’s easy to see that Shkreli is no professional anything, except a braggart and self-promoter. And when it comes to being a drug lord, Martin is way, way out of his league.

Or, is he?

Yes, and no. And in fact I feel for him.

Not because he’s being run through the gauntlet for his brazen price hike. The reason I feel for the guy is that he’s become a health care martyr. I mean, his personality antics aside, when compared to his compadres in the prescription drug manufacturing line of work, Martin is, well, an amateur.

Look, when you back away from the sensationalism of his story and take health care as a whole, it is absolutely full of Martin Shkrelis. Or to be more precise, let’s call it Shkrelish behavior – at least when it comes to methods of pricing drugs.

Take Diclegis for example. Originally pulled off the shelves 30 years ago due to concerns over its safety, recently it has made a raging comeback and is now the only FDA-approved medication for treating nausea and vomiting in pregnancy.

Now the price for this combination drug is around $360 for a one month supply of 60 tablets, or about six bucks per dose. Yet both of its ingredients – an antihistamine and Vitamin B6 – are widely available over the counter. And considering there’s only 10 mg of doxylamine and 10 mg of pyridoxine in each tablet of Diclegis, that’s no bargain.

Because one can easily find a bottle of 250 (25 mg) tablets of doxylamine for $10. Do the math, and you’ll see that that’s around 2¢ for the 10 mg dose found in Diclegis. For pyridoxine – vitamin B6 – it’s even cheaper; you can buy a bottle of 100 (100 mg) tablets for $5, or 0.5¢ per dose.

Add these two up, and on a milligram to milligram basis you see that Diclegis at $6 a dose, compared to the OTC generics at 3¢ per dose (we’ll round up) represents a markup by a factor of 20,000%.

That hasn’t stopped Diclegis from becoming a huge hit since its introduction in 2013 though. Even Kim K “partnered” with its manufacturer Duchesnay USA last year, to brag all across her social media profile about the drug’s usefulness. That got the FDA’s attention and Duchesnay in some hot water, but not before sales were boosted – in July 2015 alone, over 34,000 prescriptions were filled.

So it would seem that unlike poor Martin, Duchesnay USA Executive Eric Gervais is getting away with being very Shkrelish, indeed. His company is even rolling out some fancy prenatal vitamins in the US. Go figure…

Another example is Horizon Pharma. Never heard of ’em? Well, by the standards Martin is being held to, we all should have by now. In fact, their CEO Timothy Walbert not only sits on the board of several other companies, but he is also an esteemed member of the Illinois Innovation Council.

And yet, a close look at a few of the drugs Horizon Pharma markets reveals some Shkrelish pricing that would make even Martin green with envy.

Duexis is a drug marketed for chronic pain that is really a combination of two readily available over the counter drugs: ibuprofen (Motrin) and famotidine (Pepcid). Vimovo, which is also marketed for pain relief, is a combination of naproxen (Aleve) and esomeprazole (Nexium).

Duexis is priced at $1,600 for a one month supply of 90 tablets (with a coupon). That’s about $17.78 per dose. Likewise, a month’s supply of Vimovo can be had for about the same $1,600 – but you only get 60 tablets in that bargain, which would equal $26.68 a dose.

With me so far? Now, doing the same milligram to milligram comparison of these drugs against their generic constituents reveals that Duexis (generic version at 13¢ per dose) has a 13,577% markup.

And Vimovo (generic version at 20¢ per dose) is inflated by about 13,240%.

While I can certainly appreciate combining two useful items into one new, potentially better product (peanut butter and chocolate comes to mind), the % increase in price over these drugs if purchased (and even dare I say taken) separately by an everyday shopper is, like Daraprim’s case, unquestionably unjustified.

But wait – the best example in Horizon’s lineup has got to be Rayos, a low dose, delayed-release form of an extremely common steroid called prednisone. Marketed by Horizon as an “innovative therapeutic option…” for arthritis patients, the price for a one-month supply of 60 (5 mg) tablets of this little gem will set those patients back around $3,300.

That’s uh, $55.a.pill.

But consider that 90 tablets of the same 5 mg dosage of regular prednisone (that is NOT packaged in a time release tablet) will set you back a whole $10 – or around 11 cents a pill.

Which means that Rayos, when compared to its immediate release formulation cousin, drum roll, please…is marked up by a factor of over 49,900%.

Innovative, indeed.

But you don’t see Mr. Walbert being chased around the halls of Congress, or jumping into the wrong SUV on live television.

So while Martin Shkreli is forced to play patsy, these other, “legit” executives are laughing all the way to the bank. But that isn’t even the reason I feel for the guy. Or why I consider him to be a beaten and bloodied martyr.

I feel for him because, like so many of us regular folks, yet unlike his collegial compadres, Martin made a mistake. That’s all. But it was a doozy.

Which was to take on one of the most vocally (and politically) active special interest groups in the world – those afflicted with HIV. And to then suddenly hold a drug over their heads that can save their lives, and not one that can be found in medicine cabinets throughout the land.

Which actions by the way make great fodder for the high theatre of the policy stage, where all manner of lawmakers and other political figures can grimly smile for the cameras, point their fingers, and make hay out of someone else’s perceived cruelty to their fellow human.

So what Martin did wasn’t unique at all within the world of legalized drug kingpins. He just picked the wrong people to mess with. And for his actions – shame on him, to be sure. But while he may smile and smile at the probing questions of congress members, there’s just no way he will escape the wrath of the Court of Public Opinion – to whom he may always be a villain.

But the next time you think about Martin Shkreli, remember that he is a martyr. Because even though he may be a world-class opportunist, he certainly isn’t alone. Except maybe in how he is being persecuted by the media, portrayed to the public, and prosecuted by lawmakers.

Physician. Health Insurance Agent. Author. Health care humorist. Medical satirist. Disruptor. At your service. My name is Kevin Wacasey, and I’ve been practicing medicine since 1994. When I graduated from medical school, I took an oath to do no harm to my patients. To me, that includes financial harm. But since health insurance took over health care over 40 years ago, health care prices have skyrocketed. And despite what we’re told by the media every day, it isn’t the costs of health care that are outrageous; it’s the charges. So if you’ve ever wondered why we spend so much on health insurance and health care, then come along and join me as I explore the crazy world of Healthcareonomics. Health care doesn’t have to be expensive. Let me show you how. For speaking opportunities and to pass along your questions/comments, please email me at drw@healthcareonomics.com.

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