Yale and Harvard mobsters out of the way , and I ’ m going to come on and do it my way .” It ’ s very deliberate . That message is deliberate , that I ’ ve been doing pharmaceutical cases for 40 years . Every time I walk away and I say , “ What ’ s the difference here ? Why is a company able to sell opioids the same way mobsters would sell cocaine , but the mobster that sells cocaine goes to prison and the mobster who sells opioids for example , or they make a lot of money , nobody messes with him ?”
This guy said , “ I really like that business .” That ’ s what Devlin is based on . He ’ s an interesting character , a complicated character , but he takes control of this business just like any other mobster would .
Farron :
We ’ ve seen the term “ middlemen ” in the news lately and headlines about the astronomical and unfair cost of drug prices for Americans . In fact , New York Times currently had a column just not long ago focusing on that issue . Can you explain who the middlemen are ? Who are the PBMs ? What are they and how they affect how much we ’ re paying for medicine ?
Mike :
Yeah , so it ’ s an interesting thing . We filed the first PBM insulin case in the country , my law firm did . I based this book on all of that . After we filed that lawsuit , you started seeing New York Times write about it , Washington Post . All of a sudden , the American public is hearing PBM , PBM . They don ’ t even know what in the heck it is , but what it is , the best way I can describe it is illegal fiction . Here it is .
People came into the pharmacy business and they just said , “ Look , there needs to be somebody between the manufacturer and the pharmacy . And that person ,” I don ’ t know who , there wasn ’ t any reason for it . Government could have done this just as easily , “ but we ’ re going to be a private entity and we ’ re going to determine what the prices of these drugs should be and we ’ re also going to determine which drugs are going to be available at a pharmacy , where an insurance company will pay for the drug .”
You follow me ? The middleman , that person making those decisions . Now , here ’ s how it works for the middleman . The middleman gets kickbacks from Pfizer or Merck or Bear , any of the big companies . They get kickbacks for putting that drug that Pfizer makes on this list of drugs that are going to be paid for by the insurance company at the pharmacy . There are plenty of other drugs that are just as good . There are plenty of other drugs that are 10 , 20 , 30 times less expensive . But the middleman , the PBM , is what ’ s driving that relationship .
Then people , they wonder , why is my medicine so expensive ? Well , first of all , the middleman is getting paid . The PBM is getting paid to set the price , to set the price , and to say to that manufacturer , “ If you don ’ t play ball , if you don ’ t play ball with me , Mr . Pharmaceutical Manufacturer , you don ’ t play ball with me , you ’ re not going to end up on the list .” That ’ s why I equated , it ’ s basically extortion . They have all kinds of ways they dress it up . Oh , it ’ s rebates , it ’ s administrative fees . It ’ s ridiculous , it ’ s nothing different than a mobster in New York that goes up and down the road saying , “ I ’ m going to give you protection . If you don ’ t participate with me , things aren ’ t going to go well .”
Well , that ’ s what the PBM does . The PBM can put a pharmacy company out of business .
Farron :
The Federal Trade Commission has released information showing that the three biggest PBMs , which you have CVS / Caremark , Express Scripts , and Optum Rx , they dramatically mark up specialty generic drugs to affiliated pharmacy . What is our best way of fighting back against this entire process ? Because it ’ s not just the one drug here , the one drug there . It ’ s not just this one pharmacy . It is as you point out and you talk about and you ’ ve done it in interviews , you do it in the book , it ’ s the entire industry . What , if anything , can be done with this issue ?
Mike :
To believe that the average mom and pop on the street can do anything about this by themselves is crazy . It ’ s imaginary thinking , but what can be done is first of all , people to understand what ’ s happening to them . See , to me , there ’ s nothing scarier about this issue than the fact that people don ’ t even understand it . They don ’ t even know what ’ s happening to them . Who is this middleman ? What I call the middleman mobster . Who is that person ? How did they get there ? Where did they come from ? What do we do about it ?
Well , the truth is , there hasn ’ t been an administration in my lifetime that ’ s done anything about it . Until an administration can almost do it with an executive order , they could control what that PBM is doing , Congress could do it . The problem is that you have money coming to Congress at such an incredibly high rate that the pharmaceutical industry is just right below the oil and gas industry , and the weapons industry to control what Congress does . The money is staggering . To say , “ Well , Mom and Pop can do something about it ,” they really can ’ t . But Mom and Pop can get so angry that they put so much pressure on the right senators or the right representatives .
Now , we ’ ve seen this before . We ’ ve seen it with opioids . That ’ s what happened with opioids . The government didn ’ t do anything . We sued the manufacturers and the distributors and the pharmacies , and all of a sudden everybody was paying attention to it . The same way with something called PFAS , which is a fluorocarbon that ’ s killing people all over the world . We ’ ve been putting it in our water and nobody did anything about it until we sued them . Then Congress starts paying attention . The media finally wakes up and says , “ What ’ s going on here ? What is this stuff ? Why does it cause cancer ? Why
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