Robyn O'Brien

About Robyn O'Brien

Robyn O’Brien is the co-founder of rePlant Capital, an impact investment firm, deploying integrated capital from soil to shelf in order to build soil health and financial resiliency for farmers. She is also the founder of Do Good, a strategic advisory firm, and the AllergyKids Foundation. Random House published Robyn’s book, The Unhealthy Truth, in 2009, and her TEDx talks have been translated into dozens of languages and viewed by millions around the world.

Posts by Robyn O'Brien:

January 26 2017

How Americans “Took It On the Chin:” 20 Things to Know About Mylan and the EpiPen

Robyn O'Brien Food Allergies, From Robyn 0

This morning, CBS News ran a story interviewing the CEO of Mylan, Heather Bresch. In it, she discussed the price of EpiPens.

It’s a critical issue. Lives are at risk. Parents sometimes need as many as 4-8 sets of EpiPens, if they have multiple children with food allergies. The skyrocketing price of the device made it so that many parents can no longer afford to keep their children safe. The coupons introduced by the company aren’t always working, as we continue to hear from families paying over $300 for one set.

As the #epigate story broke last year, we heard from pharmacists who spoke about crying mothers at their counters, no longer able to afford EpiPens. We heard from mothers who split their packages in two, putting a child who may need two injections at risk. And we heard from families who chose between buying an EpiPen and paying their rent or mortgage or food bills. But without a doubt, the hardest conversations we had were with the parents who lost their children to a life-threatening allergic reaction.

So I watched with interest when the CBS anchor, Norah O’Donnell, said to Mylan’s CEO, “You really took it on the chin.” To which a remorseful looking Ms. Bresch, nodded “yes,” like a child caught with her hand in the cookie jar.

And my heart broke as I watched it, not for Ms. Bresch, but for the families I know who have lost their children to a life-threatening allergic reaction. The deaths are happening too frequently, too many in the last year alone, as the price of her device skyrocketed.

And I thought, “Ms. O’Donnell, I want you to hear the stories of these parents, because they are the ones who “took it on the chin.””

And as I listened to Ms. Bresch once again try to deflect blame, I thought about how Americans pushed for a Congressional investigation into Mylan’s price gouging, and how she flew into DC on a private jet, yet failed to answer with any certainty almost all of the questions presented by the Congress.

Since then, Mylan’s CEO has been largely missing from the public eye, but in the face of an announcement that Cigna will no longer cover her top revenue generator, that CVS Pharmacy is launching an alternative at 1/6 the price, and the news from Auvi-Q that they are returning to market in February, Ms. Bresch appeared on CBS News this morning.

But I could not stomach her answer that she was the one that “took it on the chin.” Not given how many families I know who have lost their children, not given how many I know who still can not afford the device. I obviously wasn’t alone, as the response to Norah O’Donnell’s tweet about the segment speaks for itself, which you can read here.

It reminded me of points that we shared last year, as #epigate hit: 20 things you may not know about Mylan, the company that makes EpiPen. These 20 points are why, before pointing the finger at anyone else, the company has a lot to take care of internally.

20 Things You May Not Know About the EpiPen Company

The price of the EpiPen has increased 17 times since Mylan acquired the company in 2007.
Mylan left United States for a tax inversion. It moved its headquarters to the Netherlands to avoid paying higher taxes and to avoid a takeover.
The Dutch maneuver and movement of the company’s headquarters overseas, which transferred a large chunk of Mylan shares to a special foundation called a stichting, also acted as a poison pill that would undermine takeovers.
Senator Joe Manchin (of West Virginia) has a daughter who is the CEO of Mylan.
Mylan was originally a West Virginia company where the Senator is from.
Even Senator Joe Manchin said the tax inversion should be illegal.
EpiPens were about $57 when Mylan acquired it. Today, it can empty pockets of $600 or more in the US
EpiPens were invented in 1977, almost 40 years ago. A patent life is usually 17 years.
Mylan’s profits from selling EpiPens, which they have aggressively, famously marketed, hit $1.2 billion in 2015.
That year, Bloomberg reported that the epinephrine-delivery system represented 40% of Mylan’s operating profits.
EpiPen was developed for the U.S. military for treating exposure to nerve agents in the course of chemical warfare
The top five executives of Mylan pull in over $85 million dollars. The CEO makes about $19 million.
The CEO claimed to have an MBA from West Virginia University despite being 22 credits short of completion.
EpiPen Canada has not raised its prices in any significant way.
In France, two EpiPens cost about $85. Two EpiPens in the U.K. cost 89.99 pounds.
EpiPens in Australia cost about $40 AUD.
EpiPens in the U.S. cost more than anywhere else in the world.
The price of EpiPens in the U.S. is up almost 600%. The CEO’s salary is up 800%.
According to Wells Fargo, Mylan raised prices by more than 20% on 24 products, and by more than 100% on seven products. The analyst who wrote the report warned that Mylan could draw “greater regulatory scrutiny and headline risk” as a result of such price boosts.
The CEO, Heather Bresch, interviewed today for “taking it on the chin,” spoke about her over 90% market share and monopoly before Congress. She is one of the top paid executives in the pharmaceutical industry.

The bottom line is that lives are at risk. Kids are “taking it on the chin,” parents are “taking it on the chin.”

Some families need as many as 8 sets of EpiPens if they have multiple children with food allergies. They can no longer afford to keep their children safe. It’s hitting parents and taxpayers.

I have heard from a mother who said two EpiPens didn’t save her child. I’ve also heard from Congressmen and countless others whose lives have been directly impacted by Mylan’s price-gouging.

You have to wonder, in the company’s cost-benefit analysis, what is the value Mylan placed on a child’s life? What price elasticity did they discover when Ms. Bresch and her team decided to jack up the price of EpiPens seventeen times? What process did they go through in deciding to jack up the price of seven other drugs in their portfolio over 100% last year?

And is it really Ms. Bresch who “took it on the chin”?

If you were to speak to the families who lost their children, they would tell you otherwise.

I sincerely hope that their voices are heard, too.

Written in memory of Sabrina, Emily, Oakley, Joseph and the countless other children whose lives have been lost to a life-threatning food allergic reaction.

More information can be found here on their proposed “price cut” and other concerns from families, those in the Senate and business analysts:

http://finance.yahoo.com/news/mylan-says-just-cut-price-143319975.html?soc_src=mediacontentstory&soc_trk=fb

http://www.cnbc.com/2016/08/24/heres-what-you-need-to-know-about-the-ceo-behind-the-big-epipen-price-hikes.html

http://www.nytimes.com/2016/08/24/upshot/the-epipen-a-case-study-in-health-care-system-dysfunction.html

http://video.cnbc.com/gallery/?video=3000545619

January 21 2017

Consumer Feedback On Mylan’s EpiPen Price Gouging

Robyn O'Brien Food Allergies, Health 0

Recently, Cigna announced that they are no longer covering Mylan’s EpiPen, CVS Pharmacy announced a low cost generic alternative, Adrenaclick, an epinephrine device with a price point at 1/6 the cost of an EpiPen, and Auvi-Q announced that they are returning to market in February.

Last week, I appeared on FOX Business to discuss all of this, as well as the impact that the Trump Presidency might have on drug pricing. In the segment, we also discussed the market makers and middle men that help to secure Mylan’s revenue model.

Then a funny thing happened on the way to my inbox. A PR reached out to me from Mylan Pharmaceuticals. FOX Business has been trying to reach them to no avail. I’ve been a voice in this space for over a decade. What struck me is that the day before, Auvi-Q announced that it was returning to the market on Valentine’s Day.

What had once been a monopoly suddenly wasn’t, and from Cigna to CVS Pharmacy to Adrenaclick to Auvi-Q, Mylan now faces some serious competition. They can no longer hide.

So in order to give Mylan’s PR people an idea of what consumers are saying, I reached out to our online community for feedback. Perhaps the most heart wrenching was from a mom who just lost her son over Thanksgiving. Two EpiPen devices were not enough to save his life. It was too late.

Here are some honest and heartfelt messages from consumers (we did not include those laced with profanity), not just for Mylan, but for all who are providing life-saving devices to our families:

They failed the people they were supposed to help. ~Jennifer

They victimized already suffering families. ~Kelly

I just checked prices via my insurance unit d healthcare and all my options seen 370 per two pack or more. I see no change from last year. I would like them to lower their price will all insurance programs to a reasonable price considering I have to buy 4 2 packs (2 kids and 2 schools) ~Colleen

I’ll be going to CVS for their generic, priced at 1/6 the price of the actual Epipen today, and will never again support Mylan as long as Heather Bresch is CEO. ~Cindy

One question: Why haven’t they dropped the price? We all know the answer to that question is greed, but I’d be interested to hear their answer anyway. ~Joe

Too little too late. Maybe they should think next time before gouging families for life saving medications. We will never see that money that we were overcharged. Shameful! ~Barbara

Your corporate culture of arrogance is finally catching up with you.. ~Amanda

Ask them where we sign up for refunds for past overpriced purchases? Last year my out of pocket was $1300 with the coupons and those expire this month. ~Jen

I’m on an insane High ded plan aka catastrophy insurance but pay premiums like it’s a real plan. LOL. $8K family deductible. Epis aren’t my only issue here but for something you HAVE to buy EVERY year and multiple packs to cover school, off site after school, dads house, etc. it’s insane. I’ve had to split packs at school and pray they grab someone else’s if they need a second pop. ~Jen

Please ask how they arrive at pricing, both for brand and generic, as well as pediatric and adult dose. I am referring specifically to the insanity we spoke of a couple weeks ago,whereby my insurance company paid the most for the pediatric generic epinephrine. ~Valerie

Today’s consumers are not as stupid as you take them to be. ~Nina

Please tell them what goes around…comes around. Do the right thing when it comes to pricing in relation to profits. Care about the individuals who are dependent on your products for their health—especially the children. ~Kerry

How can we work together for the greater good, which will increase your bottom line when you give value to people.

That’s if they care about people ~Liz

Apologies would be a good start. ~Alison

No thanks. ~Amy

That it’s too little too late and we are moving on to other devices that we can afford, from companies that did not play with our children’s lives for profit. ~Susie

It’s hard to decide what to tell them. They betrayed the trust of the consumers who need life saving medication. I am struggling to gather questions or thoughts on what to tell them. ~Pamela

Epinephrine is a life saving medication. Deliberately making it into a business money maker took this critical medication out of the hands of those that needed immediate access to it. Trust lost is hard to regain. ~ Ann Marie

Please tell Mylan that the voice of the consumer has been heard. ~Jayne

I just yesterday tried to fill my EpiPen prescription at CVS and even WITH the $300 coupon, my out of pocket cost would’ve still been over $300.

I have commercial health insurance with United Healthcare. Luckily I was at CVS and was able to get the generic alternative for $110 (for two pens.) ~Jennifer

That they should be ashamed for price gouging food allergy families. For taking advantage of our fears of losing our children to anaphylaxis. For not coming up with a way to truly make epinephrine available and affordable to everyone who needs one prior to being “caught.” For not being the leader of taking on the PBMs to help fix healthcare. For doing nothing to bring a more updated, innovative epinephrine device to food allergy families that is smaller and more user friendly. They chose profits over our children and we are mad. ~Elizabeth

They don’t want a cure for us. Then they’d lose their “baby”. Everything is a show. They took advantage of a vulnerable group though, and so the cat is out of the bag that they have no ethics. Yes, they are for profit. But they abused us and everyone knows it! Their image is almost beyond repair. And now that there are multiple options available, including Auvi-Q which totally blows them out of the water, they know they are going to sink. ~Jillian

The Edwards brothers are putting them to shame. The irony is their Auvi-Q brand is going to end up being all about TRUST. Something Mylan took for granted. That is very difficult to gain back. They have to work for it. Actions speak louder than words. They have proven that they only care about lining their pockets. Probably the only thing they can do to even begin to salvage any kind of respect and trust is for Heather Bresch to step down, and appoint someone that really cares. ~Jill

That now that there are more choices on the market, we will CHOOSE to go with companies that have better business ethics and actually see their customers as real people and not just profit centers. ~Marina

They should refund the difference between what they charged and what Audi-Q is charging directly to the families that paid their outrageous prices to save their children. ~Paul

Ask them how much they have paid to pharmacy benefits managers in deals and kickbacks to ensure that EpiPen (or its generic) is the only EAI listed or the preferred EAI listed on national/large formularies. Ask them to outline how’s these deals are negotiated. Ask to see the contracts. ~Leading pediatric allergist

I am so angry and saddened that it wasn’t enough to make a profit (as they should), but making a huge profit and then an even BIGGER profit was the modus operandi here, all at the expense of families who just want to keep their allergic loved ones alive! Heather Bresch’s greed preyed upon families’ fears and that is not ok. We’re not talking about a drug like Viagra (which is covered by Medicare BTW…). Epinpeherine is the only thing that will stop death for those in anaphylaxis. ~Elizabeth

I’d like them to feel the pain of what I’ve been through as a food allergy parent for 18 years. And the financial burden they’ve put on families who are already struggling enough. And tell them I’m glad Auvi-Q is back, hard as Mylan might’ve tried to get rid of them. ~Donna

We were forced to miss house/car payments, not buy groceries, not even be able to afford the expensive allergen safe foods for our daughter.

I want to know -why do they value their $ over so many people’s lives? Why instead of taking a pay cut did they let so many employees go ? ? ? Right before Christmas?

(Obviously more questions than things to tell them. Personally, if I had the chance to say anything to them it wouldn’t be too nice )

You are cruel, selfish bastards. I hope you make peace with God someday, because until you do you, you have a very hot seat next to the devil.

You are in a position that is paid to help people, instead you paid yourselves to willingly put lives at risk. Day after day you woke up and made that choice. ~Jennie

And one more for good measure:

I have 2 daughters who require an epi-pen due to peanut allergies. My older daughter uses the adult dosage, while my younger daughter requires the pediatric, or ‘junior’ version.

During the course of my discussion with my mail in pharmacy regarding the price difference between adult and junior pens, as well as the LACK of a difference in consumer price between the generic and name brand (both of which are manufactured by Mylan, by the way) I was told that my pharmacy’s cost for the epi-pen, epi-pen Jr and the generic equivalents are as follows:

BRAND:
Epi-pen $613.48
Epi-pen Jr. $613.48

GENERIC:
Adult $297
Junior $782.51

No, that is not a typo. The generic junior costs my pharmacy almost $500 more AND is, in fact more than the brand version.

My cost as the consumer is considerably less, however, I am still paying more for my younger daughter than my older one, and my cost is the same, whether I choose the generic or the name brand.

Clearly Mylan has failed to live up to their promise of a less expensive generic version and is continuing their very shady business practice. Despite numerous attempts, I was unable to speak with anyone at Mylan who could provide an answer as to the price discrepancy.

Please feel free to contact me if you have any questions. I am absolutely livid!

Any questions?

January 19 2017

This Valentine’s Day: Kaléo Returns with Auvi-Q

Robyn O'Brien Food Allergies, Health 0

KALÉO announced today that AUVI-Q will be available by prescription nationwide on February 14, 2017. This is a story we have been following since twin brothers, Eric and Evan Edwards, first launched the device several years ago. The company has invested considerable time, meeting with the food allergy community and the pharmacy benefit managers, also known as “PBMs.” The PBMs are the middle men or market makers who decide what products go into which plans and onto which pharmacy shelves. Three PBMs determine the market for the entire pharmaceutical industry. As you can imagine, negotiating with these market makers is difficult given the lack of transparency in the industry.

As a result, Kaléo brings Auvi-Q to market under a new system in order to address the needs and concerns of the food allergy community.

More than 200 million Americans with commercial insurance, including those with high-deductible plans, will be able to obtain AUVI-Q for $0 out- of-pocket.
AUVI-Q will be available free of charge to patients with a household income of less than $100,000 who do not have government or commercial insurance.
The cash price for AUVI-Q is $360, and will be available to those patients without government or commercial insurance.

Kaléo, a privately-held pharmaceutical company, today announced the AUVI-Q® (epinephrine injection, USP) Auto-injector will be available by prescription starting February 14th, and announced AUVI-Q AffordAbility, a first-of-its-kind access program for AUVI-Q. Through this new program, patients with commercial insurance, even those with high-deductible plans, will have an out-of-pocket cost of $0. For patients who do not have government or commercial insurance, and have a household income of less than $100,000, AUVI-Q will be available free of charge. In addition, the cash price for AUVI-Q is $360 and will be available to those patients without government or commercial insurance. Each AUVI-Q prescription includes two Auto-injectors and one Trainer for AUVI-Q.

“We met with patients and physicians and listened to the very real challenges in the current healthcare environment with obtaining access to affordable medicines,” said Spencer Williamson, President and CEO of kaléo. “As a result, starting February 14, for more than 200 million Americans with commercial insurance, including those with high-deductible plans, the out-of-pocket cost for AUVI-Q will be $0.”

AUVI-Q is a FDA-approved prescription medicine used to treat life-threatening allergic reactions, including anaphylaxis, in people who are at risk for or have a history of serious allergic reactions. It is an epinephrine auto-injector with innovative features such as voice instructions that help guide a user with step-by- step instructions through the epinephrine delivery process and an automatic retractable needle system, a first for epinephrine auto-injectors, that injects the epinephrine and retracts the needle back into the device within seconds.

“We know how important it is that severely allergic patients have an epinephrine auto-injector that can be with them at all times and used correctly, even without training, during a panic-stricken allergic emergency,” said Eric Edwards M.D., Ph.D, Vice President of Product Strategy at kaléo. “We are excited to make AUVI-Q, an epinephrine auto-injector with innovative features, available for millions of patients living with severe, life-threatening allergies.”

AUVI-Q AffordAbility is a first-of-its-kind program and commitment for AUVI-Q, designed to provide affordable access to this potentially life-saving epinephrine auto-injector for eligible patients. This new program removes potential and previously experienced insurance barriers, restrictions and delays, even for those commercially-insured patients with high-deductible plans. AUVI-Q will also be available via a direct delivery service, that can ensure the best expiration dating for AUVI-Q. For live assistance in filling an AUVI-Q prescription, any patient, physician or pharmacist will be able to call 1-877-30-AUVI-Q.

Identical twin brothers, Eric and Evan Edwards, the inventors of AUVI-Q, grew up with life-threatening allergies. They know what it is like to live in fear of that life-or- death moment, both as patients and parents of food-allergic children. Their goal was to develop an epinephrine auto-injector that contained innovative features, such as a voice instruction system that helps guide patients and caregivers step-by- step through the injection process. Eric and Evan Edwards believe and trust in AUVI-Q, not only for themselves, but also for their children and other families who may have to depend on it to administer epinephrine during an allergic emergency.

To learn more about AUVI-Q, please visit www.auvi-q.com.

About AUVI-Q

AUVI-Q (epinephrine injection, USP) Auto-injector is a prescription medicine used to treat life-threatening allergic reactions, including anaphylaxis, in people who are at risk for or who have a history of serious allergic reactions. AUVI-Q contains epinephrine, a well-established, first-line treatment for severe, life-threatening allergic reactions that occur as a result of exposure to allergens including food such as peanuts, tree nuts, fish, shellfish, dairy, eggs, soy and wheat; insect stings or bites; latex and medication, among other allergens and causes.

AUVI-Q is the only compact epinephrine auto-injector with a voice instruction system that helps guide patients and caregivers step-by-step through the injection process, and a needle that automatically retracts following administration. In anaphylaxis emergencies, it is often individuals without medical training who need to step in and deliver potentially life-saving epinephrine. AUVI-Q was designed through careful analysis of the situations where epinephrine auto-injectors are used and with significant input from the allergy community that relies on it incorporating Human Factors Engineering (HFE). HFE is about designing products or systems that are easy to operate and, most importantly, support correct use, with the goal to remove the potential for error. For more information visit www.auvi-q.com.

January 17 2017

The Power of Dark Greens and Spinach

Robyn O'Brien Health, Real Food, Solutions 0

Reposted with permission from Functional Formularies, a company pioneering the field of food as medicine.

Some plants have concentrations of micronutrients that are exceptionally high. Tomatoes and lycopene, Brazil nuts and selenium, or limes and vitamin C for instance. Spinach is a great source of several, highly protective nutrients. It contains large amounts of glutathione if eaten raw. It is also an excellent source of magnesium, the eye-protecting carotenoid lutein, as well as calcium and vitamin C. But spinach’s greatest contribution to our body’s nutrient needs might be its potassium nitrate content.

Of course spinach isn’t alone. Swiss chard, beet greens, mustard greens and romaine lettuce are also very high in potassium nitrate. All are excellent choices to eat daily. Potassium is extremely important on its own, but potassium nitrate is unique. This form of potassium is highly effective at helping the body correct major imbalances in the area of hemodynamics. Factors such as blood pressure, platelet aggregation, and a variety of inflammatory mediators need to be constantly adjusted by the body based upon the situation and/or what our diet has been like over the past several days.

Many people eat foods that create significant imbalance. Their blood pressure rises with an inability for the smooth muscle fibers that make up artery walls to relax. Often a number of factors increase an individual’s chances for forming a clot. These are life changing (cerebrovascular accident) and sometimes life-ending process (myocardial infarction) when they occur regularly and/or too intensely.

Enter dark greens, most notably the aforementioned ones that are high in potassium nitrate. When we absorb this form of potassium we immediately get help in the areas needed. Blood pressure drops as nitric oxide production increases and the smooth muscle arterial walls relax. Inflammation is curbed as the antioxidants and essential micronutrients work their free radical-scavenging magic. Platelet aggregation is decreased as both the potassium nitrate and other substances (such tocopherols) thin the blood.

One recent investigation revealed this unique ability to counter the effects of a typical Standard American Diet (SAD). Rats were fed a high fructose-containing diet coupled with a large amount of highly processed fats and oils (this by the way is possibly the most lethal combination of macronutrients in a population’s diet). The results were amazing. The consumption of spinach, rich in potassium nitrate, corrected more than just blood pressure and markers of inflammation, it also significantly improved insulin resistance or reversed processes associated with diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018658/pdf/FNR-60-32010.pdf

Li T, Lu X, Sun Y, Yang X. Effects of spinach nitrate on insulin resistance, endothelial dysfunction markers and inflammation in mice with high-fat and high-fructose consumption. Food & Nutrition Research. 2016;60:10.3402/fnr.v60.32010. doi:10.3402/fnr.v60.32010.

In summary, we could all do better by having more spinach salads or smoothies, more Swiss chard or beet greens in our stir-fried vegetable dishes, and more mustard greens in our soups and stews. Enjoy!

John Bagnulo MPH, PhD. – Director of Nutrition

January 13 2017

Head of CVS Pharmacy, A Mother of Four Responds to EpiPen Pricing

Robyn O'Brien Health, Food Allergies 1

Today, a life threatening allergic reaction sends someone to the emergency room once every three minutes. It’s costing our economy $25 billion dollars a year—in drug costs, lost productivity, special dietary needs and more.

And it’s costing us over $600 every time we purchase an EpiPen.

That last statistic is what launched the food allergy world into action. Mylan jacked up the price of EpiPens so many times in eight years that families could no longer afford them. So parents made a lot of noise, and in August 2016, we launched #epigate which brought attention to the price-gouging. Mylan’s share price fell 24%.

But even before that started, there was another mom of four, witnessing all of this. She held a huge role, not as an advocate, but as the head of CVS Pharmacy. Like me and millions of others, her youngest suffers from life-threatening allergies. And like all of us, she saw an opportunity to do better.

As the head of CVS Pharmacy, Helena Foulkes has done an incredible job leading CVS Pharmacy, as first seen in the company’s move to remove tobacco products from their stores. She also led her company’s effort to work with Impax, the maker of the generic version of epinephrine, Adrenaclick, to bring an epinephrine product to market at a price point that families can afford.

When the #epigate conversations started in the summer of 2016, Adrenaclick cost about $200. Still high and without a robust supply chain, it was not the right fit. Consumers and pharmacies shared concerns that if demand hit, there were questions about whether or not the the company making Adrenaclick would be able to provide the life-saving devices to the millions who need them.

Through the second half of last year, CVS worked with Impax to ensure that it could. And yesterday, CVS announced that they would carry the Adrenaclick at $109.99—the same price that an EpiPen cost over 8 years ago. A full 1/6 of the price of an EpiPen today.

The headlines took over the food allergy world. They had been heard not only by one of the largest pharmacy chains, but they had also been heard by a mother of four inside of the company who personally understands how food allergies impact millions of lives. And she demonstrated remarkable leadership.

Food allergies don’t care where we work or who we voted for. They don’t discriminate in the lives that they take, and it is on all of us who are part of this to not only find a solution but also to do everything we can to protect the millions of Americans now dealing with this condition.

Adrenaclick is a different device. Education will be required to teach consumers about it, and training is always required with any life-saving epinephrine device. Is it perfect? No, but none of them are yet. And the more choices that we have on the market, the better the devices will become, and the more lives we can save.

Think back to that first cell phone? Imagine if we’d stopped there. Competition is in the best interest of consumers. Competition yields the best product.

When I spoke with CVS today, they said, “We believe in giving consumers informed choice.” That is something that I have said countless times myself in my work in the food industry.

As Americans, our democracy is built on informed choice – from what we choose in the pharmacy, to what we choose in the grocery store, to what clothes or cars we buy.

It’s no surprise that this first move comes from CVS. If you remember, they were the first to remove tobacco products from their stores. Why? Their mission is to help people on their path to better health.

They will be helping millions of Americans with food allergies, by offering a device at a price point that many can afford.

Mylan’s monopoly has put too many lives at risk. They’ve priced consumers out of securing the devices needed to protect their loved ones. CVS stepped in to help.

Americans deserve an informed choice, a basket of products from which to choose when it comes to protecting their loved ones with food allergies.

Monopolies only benefit the monopolist.

As CVS moves to provide more options and choice, it opens up the category to other players, too. And with Auvi-Q coming back on the market in 2017, that can’t happen soon enough.

Thank you, CVS, for opening the door to other products. May the best auto-injector win.

January 9 2017

Meet the Mafia of the Pharmaceutical Industry

Robyn O'Brien Health 0

With Mylan announcing the launch of their new Mylan Pharmacy program, more attention is hitting the middle men in the pharmaceutical industry, the pharmacy benefit managers (PBMs). Mylan’s new “solution” does nothing to address the sky rocking price of EpiPens and what has become known as “epigate.”

A handful of companies, along with Mylan, have seen their share prices shoot into the stratosphere on the backs of sick Americans and those managing chronic conditions and diseases.

This article from the American Pharmacy Purchasing Alliance lays out the situation:

The healthcare costs in the United States have steadily risen over the years. This has made it almost impossible for ordinary people to obtain early and ongoing medical attention, properly manage their health conditions, and stay away from serious illnesses and even death that could otherwise have been avoided. This increase can be attributed to many factors but, in terms of the rise of pharmaceutical costs, a lot of the blame can be piled on pharmacy benefit managers.

These organizations (which are better known as PBMs) were originally formed in the 1960s to help process the prescription transactions of health plans. Over the years, their scope has expanded to include other services. Now, many PBMs are in charge of creating and updating formularies, liaising with drug manufacturers and partner pharmacies, managing patient compliance programs, and doing other tasks.

On the surface, it would seem that pharmacy benefit managers are assisting employers and insurers in reducing their expenses while helping patients get the prescriptions they need at lower prices. But, if you look closer, you’ll realize that things aren’t what they really seem: the organizations that were designed to help people have transformed themselves into the PBM Mafia.

PBMs and Overcharging

Perhaps one of the most corrupt practices of the PBM Cartel is overcharging. PBMs have the power to instruct pharmacies on how much copay they should charge customers; if a PBM decides to charge sky-high copay, pharmacies can do nothing but obey. Customers, on their part, have no choice but to pay, just so they can have their prescriptions filled.

Earnings from copay don’t stay in pharmacies, though. Pharmacy benefit managers can take back a portion of the customers’ copay after they have determined how much they would pay the drugstores. Sometimes, pharmacies are left with enough money to enjoy a profit; other times, they’re left with barely enough to cover the cost of purchasing and dispensing the drug.

Other Dubious Practices

Aside from charging exorbitant copay amounts and underpaying pharmacies, the PBM Mafia can earn from many other ways. They can get huge discounts from drug manufacturers but refuse to pass on these savings to the insurers and patients. They can also reimburse pharmacies a certain rate for a certain type of drug, then charge employers and insurers a higher rate for the same drug—keeping the difference between the two amounts for themselves.

They can even accept deals from manufacturers to keep a certain drug on health plan formularies. Manufacturers usually need to pay a substantial amount to PBMs to push this deal through, but they can recoup this investment later on since customers under the health plan will be forced to buy their product. For the PBM Cartel and big pharma companies, it’s a win-win situation.

The PBM Mafia has the opportunity to pull these stunts simply because there are virtually no laws that regulate their actions. There are a few rules in place, but many companies simply find a way around them. Because of these, a lot of PBMs can include and exclude drugs from formularies whenever they want and change their pricing structure at will—leaving insurers, employers, and patients virtually helpless.

What Can We Do About It?

The Congress is currently looking into pharmacy benefit managers and will hopefully come up with laws that will regulate how these organizations behave. While waiting for these regulations, pharmacies, insurers, and employers can demand transparency from the PBM cartel they work with and perhaps even switch to smaller PBMs that charge a flat fee and have a transparent pricing model.

January 8 2017

Watch This Dad and Daughter’s Take on “Tennessee Whiskey”

Robyn O'Brien From Robyn 0

There are so many parents out there, doing right by their kids, every single day. Many are on the front lines working to make this world a better and safer place.

But sometimes, the best work we do is the work that never gets spotlighted….that is, until now.

The joy and pride that this sweet girl has in her dad is amazing. Listen to him singing this classic, “Tennessee Whiskey.” Music can be such a salve when the world feels broken.

December 28 2016

U.S. Spends More Than Any Other Country on Health Care. Here’s Why.

Robyn O'Brien Food Politics, From Robyn, Health, Solutions 0

A study published today in JAMA shares a shocking new analysis of American health spending. The study examines costs of 155 conditions, and it turns out that just 20 problems account for half of all spending.

U.S. health spending always grows but it grew at an especially fast rate last year to over $3.2 trillion, a number so big that it’s hard to wrap your head around.

And it wasn’t just the skyrocketing price of EpiPens that drove it, though spending on prescription drugs grew at an unprecedented rate, too.

The most expensive condition, diabetes, totaled $101 billion in diagnoses and treatments, growing 36 times faster than the cost of ischemic heart disease, the number-one cause of death, over the past 18 years.

“While it is well known that the US spends more than any other nation on health care, very little is known about what diseases drive that spending.” said Dr. Joseph Dieleman, lead author of the paper and Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The annual medical spending report from the federal government shows the country spent $3.2 trillion on health care in 2015, 5.8 percent more than in 2014.

How much is that for each of us? Close to $10,000 per person, way more per capita than in any other comparable country.

In other words, our resources are tied up managing disease.

“Health care spending grew 2.1 percentage points faster than the overall economy in 2015,” the team at the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) reported in December, Today, 90 percent of Americans have health insurance coverage.

The federal government funded the expansion for Medicaid which contributed to the the growth in federal health spending. And private health insurance spending increased 7.2 percent in 2015 (up from 5.8 percent in 2014).

And the #Epigate factor? It turns out that spending on prescription drugs grew at an especially high rate — up 9 percent over 2014 for a total of $324.6 billion.

Only 6% of personal health care spending was on well-care, which is all care unrelated to the diagnosis and treatment of illnesses or injuries. Of this, nearly a third of the spending was on pregnancy and postpartum care, which was the 10th-largest category of spending.

So what does that mean? 94% of the $3.2 trillion that we spend on health care in the United States is spent on disease management.

The top 10 most costly health expenses were:

Diabetes — $101.4 billion
Ischemic heart disease — $88.1 billion
Low back and neck pain — $87.6 billion
Hypertension — $83.9 billion
Injuries from falls — $76.3 billion
Depressive disorders — $71.1 billion
Oral-related problems — $66.4 billion
Vision and hearing problems — $59 billion
Skin-related problems, such as cellulitis and acne — $55.7 billion
Pregnancy and postpartum care — $55.6 billion

Within a decade, close to a fifth of the American economy will consist of health care.

In America, sickness sells. It is driving almost 20% of our economy. How will we compete in the global marketplace in another twenty years if our capital is tied up managing disease.

It’s time to #rethinkfood and rethink healthcare, because the best health care we have is what we choose to put on the ends of our forks.

Source: Diabetes, heart disease, and back pain dominate US health care spending https://www.sciencedaily.com/releases/2016/12/161227134737.htm

December 15 2016

Meet Mylan’s Market Maker in the Pharmaceutical Industry

Robyn O'Brien Health 0

The New York Times reports that 20 states are accusing Mylan of price fixing. On the heels of #epigate, it’s no surprise. but these 20 attorney generals need to also take a look at Mylan’s middle man and market maker: the pharmacy benefit managers and the unregulated transactions happening there.

To recap: consumers sent Mylan to Congress over the skyrocketing price of EpiPens. After an extraordinary number of price hikes on little to no innovation of their best-selling EpiPen, first introduced in the 1970s, Mylan’s CEO found herself sitting center stage in front of a Congressional hearing trying to explain her business model and justify why EpiPens had hit a price tag of over $600.

She did a terrible job, and the Congressional committee didn’t buy it.

Neither did the state Medicaid or Medicare programs when they learned that the drug had been misrepresented to them, costing them millions. Lawsuits were filed, promises were quickly made. Payments changed hands.

But not enough changed, because consumers are still paying over $700 for a set of EpiPens.

Today, the New York Times launched another story that triggered another reaction in Mylan’s share price: “attorneys general in 20 states on Thursday accused six generic pharmaceutical companies, including the industry giants Teva and Mylan, of a scheme to artificially inflate drug prices…”

The company is already in the spotlight for #epigate, but what got little attention, aside from one mention by Ms. Bresch, Mylan’s CEO, are the transactions happening with the drug dealers of the pharmaceutical industry: the pharmacy benefit managers.

These middle men have carved out an extraordinary niche for themselves. They set the market for drugs.

They design the transactions between the drug companies and the end users. They play an enormous role in pricing, product selection. promotion, the spread and the sales.

There are three main pharmacy benefit managers in the U.S., commonly referred to as PBMs. Their stocks go up if the prices of drugs go up, as they make money on the spreads – the differences between what they charge the drug companies for the product and what they sell it for to the end user. Their stocks also go up if we stay sick with the skyrocketing rates of conditions like allergies, cancer and diabetes. In other words, they have little to no incentive to cut a deal and get the highest priced drugs onto the market. They make money on the size of the spread.

Since 2003, the two largest PBMs—Express Scripts/Medco and CVS Caremark—have seen their profits increase by almost 600% from $900 million to almost $6 billion.
That number, $6 billion, is larger than the current FDA budget. All three PBMs are the largest company by revenue in each of their representative states. Mylan is the largest company by revenue in West Virginia, as they engage in the art of dealing drugs.

“Dealer” is definitely the word, as their transactions resemble those you might find in a casino or the banks prior to the mortgage crisis. Why? They are unregulated, creating their markets, their own players, their own spreads and their own deals. They rig the game, and the drug companies that play nice with them win.

If a company like Mylan wants to keep a competitor out of the epinephrine space, they can buy that option. You have to wonder how that revenue is recognized by the PBMs. The transactions are done to protect market share.

Perhaps that is why Ms. Bresch was so quick to love them up at a recent industry conference. It’s bad for her business to be on the wrong side of these guys, not to mention that they can determine who, if any, of her EpiPen competitors make it into pharmacies and approved drug programs. If Mylan wants EpiPens 90%+ market share to continue, they have play nice with these pharmacy benefit managers.

Some call it extortion, some are calling the PBMs the mafia. One thing is certain: much like the banks used to be, the PBMs are totally unregulated and can set whatever spreads in whatever markets they want.

Many employers and health insurers hire pharmacy benefit managers to provide a list of coverers drugs, negotiate the prices of these drugs with the drug companies like Mylan, and then to create networks of pharmacies. In other words, PBMs are market makers.

For those of us in the food allergy world, we remember the competitor TwinJect, and we watch with deep concern as Auvi-Q tries to re-enter the channel. Mylan has worked closely with the PBMs to secure it 90+% market share that Bresch mentioned in her Congressional testimony. And deals are often made for a price that secure exclusivity. A lock up and a lock out. It drives shareholder returns for both the drug company and the PBM, and given the massive increase in revenue in both channels over the last decade, no one is complaining.

Except for the consumer and now the attorneys general in 20 states. Why? Because this price gouging is impacting the consumer who is not only buying EpiPens, but also diabetes medications and supplies, asthma meds, cancer meds and so many more. In the United States, we spend 18 cents of every dollar managing disease. These guys are at the mouth of that spending fire hose, happy to catch as much as they can.

Can we blame them? It’s their fiduciary duty to shareholders, and no one is regulating them.

But recently, Anthem Health filed a lawsuit against one of these big PBMs to the tune of $15 billion. Others are looking at the PBM channel, too, which is hidden and shrouded in back room deals and under the table handshakes. It truly does seem like some sort of mafia film. And it’s stunning that three companies have been able to command billions from drug manufacturers, health care plans and consumers. It’s become such a lucrative deal that United Health recently launched its own PBM and reports it to be their fastest growing revenue generator.

But according to the drug companies beholden to these PBMs, “its the mafia, extrortion, a system that does not allow access to innovation.”

And given the rates of disease in our country, that is a serious problem.

So who benefits? The long-term, multinational drug companies like Mylan and the PBMs. They end up becoming “the smartest guys in the lab” not unlike Enron claimed to be “the smartest guys in the room.”

Can we afford to have innovation in the hands of so few companies? What does that mean to pricing? To the competitiveness of the marketplace? What does it mean when it comes to protecting the health of our families?

Drug costs in the United States are astronomical compared to other countries.

And the system is not only broken, but unregulated,as we now know with the PBMs. Not only are consumers suffering, but corporations paying skyrocketing health care costs are, too.

This year, something remarkable happened. A groups of multinational companies came together to form the Health Transformation Alliance. In their words, “The current health care system is unsustainable and it costs too much. The Health Transformation Alliance’s goal is to improve the way corporations provide health care benefits in an effort to create better health care outcomes for their employees. By coming together to share expertise, the companies seek to make the current multilayered supply chain more efficient. We view it as A Better Way.”

In other words, they’re getting hosed, too.

Take a look at who is in it:

The 20 companies that formed the alliance include:

American Express
American Water
BNSF Railway Co.
Brunswick Corp.
Caterpillar Inc.
Coca-Cola Co.
E.I. du Pont de Nemours & Co.
HCA Inc.
Hartford Financial Services Group Inc.
IBM Corp.
Ingersoll-Rand
International Paper Co.
Lincoln Financial Group
Macy’s Inc.
Marriott International Inc.
NextEra Energy Inc.
Pitney Bowes Inc.
Shell Oil Co.
Verizon Communications Inc.
Weyerhaeuser Co.

There is so much more to uncover here, and we have more articles to share.

The current health care system is broken, and the PBMs certainly don’t want you to know about it.

A few weeks ago at the Forbes Healthcare Summit, Mylan CEO, Heather Bresch, had the following to say:

“The pharma pricing system was not built on the idea of consumer engagement,” she said. “It was built … on market efficiencies. It was not built on the premise of consumerism.”

As the attorneys general turn their eyes onto the price fixing by Mylan and other generics, it’s time for them to take a look at how companies like Mylan play the tables and spreads with the pharmacy benefit managers.

December 13 2016

Breakfast and Love Warriors

Robyn O'Brien From Robyn, Solutions 0

This morning a friend posted, “How do you get kids off to school ON TIME????”

And almost immediately, a flurry of moms responded.

I am in the middle of reading Glennon Doyle’s Love Warrior, and all I can think about this morning is the perfect imperfection of being a mom.

Our kids are mostly teenagers now: two are in high school and two in middle school. The last week has been full of the stress of year-end projects, concerts and finals. Each night, someone has to be talked down off of the ledge. Each morning, they have to reminded that there are only 24 hours in the day, and it will pass.

And I can’t help but think back on the ‘work in progress’ that we all are. In any given moment, we have a tendency to judge: to judge ourselves, our performance, our roles, our spouses. Maybe it helps? I don’t know. What I’ve learned in this work and the heartache that is so often a part of it is that the important thing is to be honest.

Life is joy punctuated by pain, and pain punctuated by joy. I’m pretty sure that our hearts have to break to make room for all that is meant to fit inside.

When I was in the finance world, it was numbers, black and white, no emotion. I loved it that way. I hid behind five computer screens. It was all data.

When I learned how much this generation of children is struggling, when I saw what it was doing to marriages, lives, mothers, husbands, siblings, my heart shattered into a million pieces. And I wasn’t sure that I could get back up.

In those early years, there were very few people to help me stand.

I remember one night, curled up, turning to my husband and asking him, why he was standing by me. Why did he believe me?

His answer was simple: “Because you’ve never given me any reason not to believe in you.”

He helped me stand.

And I thought about all of the heartache, the nights laying in bed where my heart hurt so much I didn’t think I could move forward, I only had a prayer and a vision: that as I lay there, on my back in the dark, with my heart open to the sky above, I’d say this prayer: “Please God, let me learn the lesson here quickly so that I can move through this suffering and into the next chapter.”

That realization was so huge. Up until this work, I thought that somehow, we were meant to be free of suffering. That it was up to us. That success was defined by how good we were at avoiding suffering.

But as we wrap another year, with more dear friends diagnosed with stage four cancers, so many changes occurring on the global stage and here at home in the U.S. I am so aware that the only thing certain in life is change.

And I can’t help but think about the rhythm in that. Growth is a special kind of pain, like the growing pains a 13 year old boy might be having, a mother’s heart also experiences. The disruption of a seed emerging from the soil to become a flower.

And rather than run from it, as I did in my twenties, I’ve learned to sit with that disruption, to know that it isn’t here forever, and to teach the kids that an emotion can not kill you, no matter how strong it is. It is there to change you.

And with all of the love and passion and guilt and struggle that is parenthood today, I once again thought about all that is going into the kids heads and hearts, as well as what is going into their bodies.

And sometimes, I wonder which is more important: the fuel we feed our heads and hearts or the fuel we feed our bodies.

The world needs love warriors. Motherhood initiates you into that army like nothing I’ve ever known.

And as the kids rolled out to school this morning, I thought about how some days we get it right, some days we get it wrong, but that every day that we get going, we are moving this whole thing forward.

So to my friend who asked about getting the kids out the door on time? A hug is as important to feed their soul as a perfect breakfast. The playground can be a battlefield. Life can be, and I’m pretty sure that what the world needs out there right now is Love Warriors.