Drug Companies, Insurance Companies, Pharmacists, the Government, Doctors and…Oh, Patients!

Recently, a relationship between Valeant Pharmaceuticals and a specialty pharmacy, Philidor, was revealed, with significant consequences to Valeant and equally significant consequences for the pharmacy. The full story is still unfolding as of this time, but the interpretations of these types of relationships by various stakeholders—pharmaceutical companies, insurance companies, pharmacies/pharmacists, the government and physicians—are often adversarial ones. Sadly, the ultimate end-user, the patient, is probably the most forgotten yet most important part of this situation.

The relationship between Valeant and Philidor has been called “deeply immoral” by none other than Charlie Munger, the co-chairman of Berkshire-Hathaway (Warren Buffett’s company). Is this correct or is it simply characterized as immoral by Congress, which is beholden to or lobbied by other entities? Is that truly the reason for hearings and explosive rhetoric on the campaign trail? Is it a way for the media to lambast and vilify doctors and pharmaceutical companies, who are convenient targets?

From this dermatologist’s viewpoint (and I am conflicted as I am on the Steering Committee for Valeant and a shareholder), this is a tempest in a teapot that is being used to assert the power of the larger pharmacies, insurance companies and pharmacists in regard to prescriptions and how they are filled. As many of our colleagues will attest, it has become frustratingly common to send a patient to the pharmacy with a prescription (or e-scribe it) only to have it changed to something else that usually is much less effective or less cosmetically elegant with only a one to five percent savings over the brand name prescription. The generics have become ridiculously expensive, making the brand name drugs relatively affordable in comparison, but this isn’t being taken into account. The insurance companies have colluded to only allow a few brand name drugs on their formulary and with exorbitant co-pays for most of them.

It was this toxic mess that Valeant, via Philidor, tried to sidestep. Whether or not one company owned the other doesn’t seem moral or immoral to me as long as the medications come to the patients if they and their physician desire that particular medication, but perhaps that is a quaint assumption on my part. In many cases, Valeant lost money on prescriptions but was willing to do so in order to offer a solution that worked, and it did. That is…until it didn’t.

Many individuals are feigning horror that shenanigans happened during this relationship, but the truth is that there are worse things happening now as pharmacists willfully substitute inferior generics for more effective brand prescriptions while pocketing huge sums or being incentivized by their parent companies to do so. Additionally, there are clearly more sinister situations where insurance companies collect huge copays for drugs that would cost less if purchased outright.

The system has many things wrong with it now, but Valeant’s attempt to allow a written prescription to be a prescription picked up by the patient isn’t necessarily immoral or unreasonable. What is unreasonable is an outrage by media and elected officials that is fueled most likely by lobbying efforts and inherent biases against doctors and—ultimately—patients. n

—Joel Schlessinger, MD, Chief Cosmetic Surgery Editor