Drugs, Money, and Secret Handshakes: The Unstoppable Growth of Prescription Drug Prices

by Robin Feldman

In the warped world of prescription drug pricing, generic drugs can cost more than branded ones, old drugs can be relaunched at astronomical prices, and low-cost options are shut out of the market. In Drugs, Money and Secret Handshakes, Robin Feldman shines a light into the dark corners of the pharmaceutical industry to expose a web of shadowy deals in which higher-priced drugs receive favorable treatment and patients are channeled toward the most expensive medicines. At the center of this web are the highly secretive middle players who establish coverage levels for patients and negotiate with drug companies. By offering lucrative payments to these middle players (as well as to doctors and hospitals), drug companies ensure that inexpensive drugs never gain traction. This system of perverse incentives has delivered the kind of exorbitant drug prices - and profits - that everyone loves except for those who pay the bills.

Genres: Economics, Nonfiction, Health, Science, Audiobook

196 pages, Hardcover

First published April 11, 2019

Reviews

[Max · Rating 4 out of 5]

This is a very interesting book. The introduction is a good example of a clear and interesting intro. It invites me to start reading and also explains what will be told. I worked in health care for six years and asked myself the same questions as the author asked, probably. Why does it all have to be so bloody expensive? This book is focused on the United States, but I can tell you that it's the same in Europe, and anywhere else on the world. The moral concerns raised by the people who are interested in this topic are just and that's why books like these need to be written and read by many people.

The story is supported by helpful figures and understandable analogies. It's a little number heavy, and not particularly an easy bedtime read. But it's very insightful and I really learned some new things. For example the recycling of drugs, newly released drugs are often old ones but in different capsules. They are then released under a new brand name and the makers can then benefit again from a patent-protected few years. (So they can get way more money for the drugs!)

So, if you are interested in health care, definitely read this book. Books like these should be mandatory for health care professionals, I think. 

Thanks to the publisher and NetGalley for the ARC. These are my opinions and are in no way influenced by the fact I got the ARC for free.

[Ell · Rating 4 out of 5]

Drugs, Money and Secret Handshakes delves into the world of pharmaceutical price gouging and all the many hidden players behind it. As expected, collusion, secret agreements and greedy middlemen conspire to conflate medication prices. The reader is left surprised by just how many middlemen have a stake in keeping medications pricey.

Robin Feldman also shines a light onto the seedy little tricks pharmaceutical companies employ to keep prices high on drugs that have been around for a very long time. Using recycling and recombination strategies to obtain new patents to keep prices high on pharmaceuticals that would have otherwise become more affordable is just one of the sneaky techniques they employ.

Drugs, Money and Secret Handshakes is an apt title. The book is both interesting and educational.

[Lindsey Gandhi · Rating 5 out of 5]

If you or anyone in your family depends on prescription drugs, you need to read this book. If I had unlimited financial resources, I would send a copy of this book along with my notes, thoughts and suggested resolutions to every member in Congress and every member in my state government. This book needs to be read and I commend the author for having the courage to write it and attempt to answer the question so many of us ask each time we visit the pharmacy - Why in the world is my medicine so expensive? Even with insurance????

Big Pharma, while they have life saving drugs is also a Big Bully to us patients. We all know the healthcare system is messed up, it's a jumbled ball of yarn that the government keeps making worse instead of better. And the pharmaceutical industry is just as messed up and corrupt. I never knew quite how corrupt until reading this book. The author does an exquisite job of laying out how the industry is structured and analyzing all the ways the drug prices get raised. It is alarming, it is scary, it is horrifying how the current system is structured to rob the patient blind while padding the pockets of drug companies. PBM's (pharmacy benefit managers) and insurance companies. Within reading the first 15% of this book, I had 7 solutions to help lower drug costs. And that's just me, one lone reader. Now imagine if the powers that be, that we elected to be our voice and our feet to move justice would take the time to really read this, research it and discuss solutions what could happen!

I have two diseases that require extensive medicines to keep me somewhat healthy - Multiple Sclerosis and Congestive Heart Failure. I have no problem paying a premium for a product or service that is of extensive value to me. And I understand the need for companies to make a profit. I have no problem with that. One of the medicines I take for MS keeps me walking and out of a wheelchair (I consider that to be extensive value). What I do have a problem with, a big point in this book, is why is that medicine now $58,000 a year when 20 years ago it was $30,000 a year? And there is a generic on the market now that is $36,000 a year. You want me to believe in 20 years the pharmaceutical company hasn't found a more cost efficient way to manufacture this medicine? And with seven other competitive MS medicines out there, this is not an issue of cost and demand. As the title says, there is alot of money and secret handshakes that go into this dishonesty. The book points out on average a brand name drug has a 76% profit margin.

A huge part of the deception is this middle group of players who are the ones determining coverage levels for patients and the formularies for insurance companies. Someone in a suit is sitting in an office making a decision on what medicine I should be allowed access to based on how much money they are getting paid, not on what is in the best interest of my disease and health, as determined by my doctor.

There are moral, ethical and legal concerns raised in this book that as a country we need to address. The author does a spot on job of backing up everything with solid facts, figures, examples and legal cases. In the end the author offers a few solutions that could be pursued to start the conversation and get the ball rolling. If you take the time to read this book, I feel confident you will find additional ideas and potential solutions as I did (by books end I had 16. Not saying all would work or are even feasible, but it's a start). The point being that if we can get the right minds to the table, there are solutions out there where patients could get affordable medicine that won't break the bank while still allowing the pharmaceutical companies to make a decent profit.

My thanks to the author, publisher and netgalley for a copy of this book in exchange for an honest review.

[Jeff · Rating 5 out of 5]

A Klaxon Call. In this exceedingly well documented scholarship, Feldman presents the case well. And what an alarming case it is. Drug manufacturers have found ways to game the system at all levels such that the existing system in the US actually *encourages* ever higher drug prices - even as patients are crying out under the strain and in many cases forgoing life saving medication due to not being able to afford it. Feldman explains the problem at all levels though four of the six chapters of the book, with the first chapter being an overall introduction to the problem and the final chapter being suggested solutions - including a range going from possibly politically palatable yet likely ineffective to very likely effective but less likely to be politically palatable. Overall a stunning work that could - and likely should - drive at least some discussions through the 2020 election cycle.

[Hannah · Rating 3 out of 5]

I received an advanced electronic copy of this book courtesy of NetGalley.

Drugs, Money, and Secret Handshakes is a detailed critique of the pharmaceutical industry, the system that encourages high drug prices, and the perverse incentives that can drive prices even higher....

hannahbrucemacdonald.com/2019/03/18/d...

[Clazzzer C · Rating 4 out of 5]

This book is a great read. It is criminal what the medical companies are able to to do to us the consumers and what our governments are allowing them to do. There were no surprises though, which is unfortunate as everybody knows that this corruption is going on around us all of the time- legal corruption, legal theft, it's criminality at the highest order. This book is based in the USA but its events are common world wide. There are multiple incidents of back slapping, collusion and brown envelopes happening all around us and we, the consumers are paying the price. Ireland, where I live has so many cases of this evident in the pharmaceutical industry here with those in need of medicine are paying through the nose for premium brands as generic brands, which cost a fraction of the price are unavailable here. This has to end, but will it in our lifetime? Not as long as the pockets of those in power are being lined. This is a very interesting and informative read. It has multiple facts and figures to back up all if the assertions, supporting all of the claims that Feldman is making, all of the accusations that are being thrown at the pharmaceutical industry. This book can not help but infuriate anybody with an ounce of scruples. It's a really interesting read.

[Susan Wisecup-Agbedzinu · Rating 5 out of 5]

I, absolutely, LOVED this book! It began by explaining, in easy to understand examples of specific instances in which, the collusion between pharmaceutical companies and PBMs is causing medications and treatments to skyrocket in the last 3-4 decades. While the author occasionally becomes a little convoluted in her explanations of the intricacies of trade law, I was able to totally understand her points after occasionally rereading a paragraph or passage.
I found myself getting more and more irate at the machinations of the players and, while I realize that money and market standing are everything to these companies, I wonder if their consciences ever bother them at all, considering that they have absolutely no consideration or feeling for the consumers and patients whom they are fleecing. I almost read the last chapter immediately after the fourth, just needing to read any hope of a solution. It’s there but I wonder, considering of the power and pockets of pharmaceuticals, if there is any hope that anyone in Congress, the FTC or the government has the balls to attack this problem, and not let go until it’s solved.

[Helena#bookdreamer · Rating 4 out of 5]

Thank you netgalley for providing this ARC in exchange for an honest review.
I thought this book was informative and compelling. Although a bit dense and at times hard to follow if you're not in the healthcare world, it does reveal some very provocative arguments about how drug prices rise. It's a unregulated, corrupt system where the middle man and drug companies make out by raising prices and cutting out the competition. It's a scary world but hopefully regulation will soon come to the rescue.

[N N]

Read the first 2 chapters (the free Kindle sample), which includes helpful, in depth explanations and real examples of how pharma manufacturers incentivize PBMs in ways that decease consumer choice in what drugs we can use.

[Andrew Swenson · Rating 4 out of 5]

Super interesting book on pharmaceutical market structure and misaligned incentives. Argues that PBMs positioning in the industry create perverse incentives to sell patients higher cost drugs, and that drug companies use a variety of tactics to delay generic entrance.

[Boris Feldman · Rating 5 out of 5]

A lucid and readable analysis of how the drug industry manipulates patent rules and middlemen to keep drug prices high.

[Evan Dragic · Rating 4 out of 5]

This was an insightful and infuriating look at the economic incentives and sorry state of the American pharmaceutical / health industries.

[Caroline · Rating 4 out of 5]

A short and accessible book on drug pricing research.

[MEDURI SUPRAJA]

A quick insight of american pharma industry, where companies fight in generic market which should decrease the price but reality isnt

[Megan Tee · Rating 4 out of 5]

Amazing book detailing just why prices have kept on climbing.

[Kelly Mai · Rating 4 out of 5]

PBM pay structure is a dooozy bro - all the headache that is the rebate scheme & for what?? smh

it was interesting to learn that rising drug costs lowkey not an issue w the insurance company more so than an issue with them being beholden to the 3 large pbms that engage in lockstep pricing based on rebate schemes it can extract during its negotiations with brand drug companies - left me lots to think ab on this bright green earth - everything ultimately turns on POLitICAL wIlL - quite lugubrious.

REVISION: MAYBE IT IS A HEALTH insurance problem bc theyre all vertically integrated with the pbms so idk anymore :))))))))