2021 Shkreli Awards

JANUARY 11, 2022 — The Lown Institute has issued its top ten list of the worst examples of profiteering and dysfunction in health care, named for Martin Shkreli, the price-hiking “pharma bro” that everyone loves to hate. This year we’re highlighting “innovative” profiteers, who have particularly creative ways of milking the health system for money.

Nominees for the Shkreli Awards are compiled by Lown Institute staff with input from readers of Lown Weekly. An esteemed panel of patient activists, clinicians, health policy experts, and journalists help determine the winners. (press release | previous winners)

#10

Suppository users experience discomfort of 5000% price increase

In 2008, a box of 30 Indocin suppositories, an arthritis treatment, sold for less than $200. In 2021, the same box was more than $10,000, Axios reported. How did this happen? The original owners of Indocin, Iroko Pharmaceuticals, raised the price a dozen times over the course of ten years; by 2018, the list price was $2,550. Then after the company was sold, the new owners Egalet doubled the price to about $5,000. And in May 2020, another company shift led to a new owner Assertio, and more price increases. The price as of October 1, 2021 was $10,350. That’s $345 for each suppository.

SOURCE: Bob Herman, Axios

JUDGES’ COMMENTS:

Drug prices in the US are completely out of discord with their clinical value.

Adam Elshaug

Adam Elshaug

Patients get it up the a** with this suppository price hike.

Gary Schwitzer

Gary Schwitzer

#9

Pharma companies use “charitable giving” to increase sales of their overpriced drugs

Drug companies want as many patients to take their medications as possible, especially their expensive ones, but high copays can limit sales. Some pharma companies have found a questionable method to get around this obstacle: funding charities that offer to pay patients’ copays. Insurer Humana is suing drug companies Biogen and Teva Pharmaceuticals for allegedly arranging copay assistance through charities they donated to, to boost sales of their pricey multiple sclerosis drugs. These drugs cost Medicare up to $80,000 per year, with copays as high as $6,500. 

The US Department of Justice also sued Teva for this scheme in 2020. Federal law prohibits drug companies from paying copays for Medicare patients, as this is considered a kickback. Teva has moved to dismiss Humana’s lawsuit; the DOJ case is still ongoing.

SOURCES: Eric Sagonowsky, Fierce Healthcare; Morgan Haefner, Becker’s Hospital Review

JUDGES’ COMMENTS:

Profits before patients through patients by patients takes corruption in healthcare to a whole new level.

Victor Montori

Victor Montori

Loopholes such as this are low-hanging fruit for legislative change, and legal action where appropriate.

Adam Elshaug

Adam Elshaug

#8

Hospital steers patients to ER for Covid testing, inflating bill as much as 30 times

Photo credit: STEVEN MOLINA CONTRERAS/The Ne​w York Times/Redux

Lenox Hill Hospital in New York City routinely charged more than $3,000 for Covid-19 nasal swab tests, although these tests usually only cost $100, the New York Times reported. Directing patients through their emergency department allowed the hospital to bill the Covid-19 tests as ER visits and tack on substantial fees.

Northwell Health, the nonprofit system that owns Lenox Hill Hospital, said these charges were appropriate because patients received “more advanced care” in the ER than they would have elsewhere. While insurers, not patients, were on the hook for these bills, these inflated prices contribute to rising premiums and out-of-control health care costs that affect us all.

SOURCE: Sarah Kliff, The New York Times

JUDGES’ COMMENTS:

Inappropriate billing practices anywhere drive fears everywhere. This act and other instances like it likely drove people from testing and care they need and deserve.

Andrew Goldstein

Andrew Goldstein

This looks like a massive failure of solidarity. It screams ‘we are not in this together.  

Victor Montori

Victor Montori

#7

Woman leaves ER after waiting seven hours without being seen, hospital charges $700

“You get charged before you are seen. Not for being seen.” That’s what Emory Healthcare wrote to Taylor Davis in an email, after her trip to the Emory Decatur Hospital ER for a head injury. Even though Davis left after waiting for seven hours and never met with a doctor, the hospital still billed her $700 for the trip, Fox 5 Atlanta reported. “I didn’t get my vitals taken, nobody called my name. I wasn’t seen at all,” Davis said.

The hospital told Davis that their protocol is to charge everyone who enters the ER a facility fee, whether or not they get seen. Emory Healthcare told Fox 5 in a statement that it was “looking into this matter and will follow up directly with the individual.”

SOURCE: Janice Yu, Fox 5 Atlanta

JUDGES’ COMMENTS:

Are they charging her for breathing their air? Or maybe she didn’t realize the water fountain was not free.

Susan Rogers

Susan Rogers

It’s hard to believe that they could write this with a straight face.

Deborah Blum

Deborah Blum

#6

Hospital claims Medicaid doesn’t count as insurance, raids accident victims’ settlements instead

Several hospital systems have been exploiting lien regulations to charge accident victims more for care, the New York Times reported. Rather than bill insurers with lower reimbursement rates like Medicaid, some hospitals opt instead to place a lien on patients’ accident settlements for a higher amount — sometimes tens of thousands of dollars more than what they normally would have billed.

One of these hospitals was Parkview Regional Medical Center in Fort Wayne, Indiana. Although Indiana has a law requiring hospitals to bill patients’ health insurance before taking anything out of a settlement, Parkview ignored the rule for Medicaid patients, insisting in a 2020 legal brief that Medicaid is “government assistance” and not health insurance.

In a statement to the Times, a Parkview official said that they no longer file liens against Medicaid patients, and that their debt collection policies have always been “conservative and fair.”

SOURCE: Sarah Kliff and Jessica Silver-Greenberg, The New York Times

JUDGES’ COMMENTS:

Why does it take a hand-in-the-cookie-jar news story to stop these practices?

Vikas Saini

Vikas Saini

Medicaid is considered insurance everywhere else in this country. I guess this hospital is living in another universe.

Susan Rogers

Susan Rogers

#5

Hospital system files 19,000 lawsuits for unpaid medical bills, while receiving $700 million in Covid bailout funds

During the Covid-19 pandemic, some hospitals halted their practice of suing patients for unpaid medical bills, but others have continued to use the legal system to hound patients with medical debt. Community Health Systems, Inc, one of America’s largest hospital chains, filed at least 19,000 lawsuits against patients for unpaid medical bills from March 2020 to May 2021, CNN reported. 2020 was CHS’s most profitable year in a decade, in part because they received $705 million in pandemic-related aid from federal, state, and local governments. 

In a statement to CNN, CHS said its hospitals only sue patients after it is determined that they have the ability to pay, and that “legal action is always the last resort.” CHS said they adopted a policy in 2021 to withdraw lawsuits against anyone making less than 200% of the federal poverty threshold, but noted that many patients did not fill out the paperwork to qualify for this aid.

SOURCE: Casey Tolan, CNN

JUDGES’ COMMENTS:

Hospitals should be designated a predator species, joining lions, tigers and the other great cats.

Gregg Gonsalves

Gregg Gonsalves

As if for-profit hospitals price gouging wasn’t bad enough… here’s a health system willfully driving financial ruin of people too impoverished to cover the bill. This is unacceptable.

Andrew Goldstein

Andrew Goldstein

#4

Drug manufacturer prices Covid-19 pill developed with federal funds at 40x its production cost

Drug manufacturer Merck’s pill molnupiravir was recently approved for emergency use to treat Covid-19 in the US, after it was shown to modestly reduce the risk of hospitalization or deaths in people with mild Covid-19. What’s the catch? Merck charged the US government $712 for a five-day course of the drug, although it costs only $18 to produce and was created using millions in government funding, according to The Intercept. Emory University originally developed this drug as a possible treatment for a mosquito-borne virus, aided by nearly $30 million in government grants.

Merck has granted a royalty-free license for molnupiravir for use in low- and middle-income countries, but the company still stands to make $5-7 billion from the drug.

SOURCE: Sharon Lerner, The Intercept

JUDGES’ COMMENTS:

This is pretty much everything wrong with the US pharmaceutical industry in one go.

Casey Quinlan

Casey Quinlan

Drug companies are only marginally less ruthless than drug cartels.

Allen Frances

Allen Frances

#3

Catholic hospital system with mission to serve the “poor and vulnerable” creates billion dollar private equity fund while cutting services at safety nets

Photo credit: National Nurses United

Ascension, the nation’s largest Catholic nonprofit health system, has created a $1 billion private equity operation that has been investing in other health care providers, and even a debt collection company, a STAT News investigation found. While other hospital systems have made money passively from investments, Ascension is unique in partnering with a global private equity firm.

Ascension says that profits from capital gains helps them care for the “poor and vulnerable,” but the system’s charity care spending has not increased along with its investment income, and Ascension initiated cuts in services at two of their safety net hospitals. One of these hospitals was closed and converted into an urgent care center, over the protests of local health care workers and community leaders. 

*Note: The Lown Institute provided data to STAT News about safety net hospitals for this piece.

SOURCE: Rachel Cohrs, STAT News

JUDGES’ COMMENTS:

Bless me, Father, for we have sinned the sins of hypocrisy. We have shown malice to our mission of serving the poor and vulnerable.

Gary Schwitzer

Gary Schwitzer

The founders of many of America’s religious hospitals are rolling in their graves.

Shannon Brownlee

Shannon Brownlee

#2

Family at heart of opioid crisis offered immunity, despite harm to millions and deaths of hundreds of thousands

Members of the Sackler family in 2014 at a celebration of their gift to the Yale Cancer Center.
Photo credit: Smilow Cancer Hospital Facebook

The Sackler family which owns Purdue Pharma, the drug company whose aggressive marketing of Oxycontin fueled the opioid crisis, may come out of the legal proceedings relatively unscathed. A bankruptcy deal approved in September 2021 would have required the Sacklers to give up about $4.3 of their $11 billion fortune, but they would have received immunity from future civil lawsuits and would not have to admit any wrongdoing, NPR reported. The US Centers of Disease Control and Prevention estimated the societal cost of opioid use disorder and overdose in America at more than $1 trillion in 2017.

As of December 2021, the bankruptcy deal was rejected by another federal judge. Purdue has stated they plan to appeal this decision, and other courts will likely weigh in on the case before the details are decided.

SOURCES: Brian Mann, NPR; Geoff Mulvihill, Associated Press

JUDGES’ COMMENTS:

The lack of accountability is classic American deference to profits over people.

Mona Hanna-Attisha

Mona Hanna-Attisha

The Sackler family needs to do approximately ten generations of penance for what they did to humanity.

Casey Quinlan

Casey Quinlan

#1

FDA fast-tracks unproven drug, defying its own advisory committee and putting millions of seniors at risk

Though not one member of its advisory committee supported approval of Biogen’s drug for Alzheimer’s Disease, the US Food and Drug Administration (FDA) gave it the green light anyway, using a regulatory shortcut to accelerate the process. The drug, Aduhelm, has not been shown to significantly reduce memory loss or cognitive decline. The drug did reduce amyloid plaque in the brain, but this has not been shown to improve Alzheimer’s symptoms. Side effects include brain swelling or bleeding, falls, headache, and diarrhea. A STAT News investigation found that the FDA was abnormally proactive in supporting Biogen, even drafting a road map to how they could get Aduhelm approved. 

The high price of the drug and large eligible population means Medicare could spend hundreds of billions each year just on Aduhelm. Already, Medicare premiums are projected to rise 15% in 2022 partly due to the cost of the drug. In response to the STAT findings, the FDA Commissioner requested an investigation of the approval by the Office of Inspector General (OIG); the OIG expects to have a report by 2023. An independent group of Alzheimer’s experts and advocates recently called for the FDA to take the drug off the market.

SOURCE: Adam Feuerstein, Matthew Herper, and Damian Garde, STAT News (Update)

JUDGES’ COMMENTS:

This is a classic of data dredging, inside dealing, and exploiting patients’ and families’ desperation to make a buck — billions of bucks in fact.

Vikas Saini

Vikas Saini

This is what comes of having the pharma fox guarding the public health hen house.

Allen Frances

Allen Frances

Weekly news for people who want a radically better health system


Judges for Shkreli Awards

Deborah Blum

Deborah Blum

Director of the Knight Science Journalism Program at MIT

Shannon Brownlee

Shannon Brownlee

Special advisor to the president of the Lown Institute and lecturer at the George Washington University School of Public Health

Adam ElshaugMPH, PhD

Adam Elshaug
MPH, PhD

Senior fellow at the Lown Institute and director of the Centre for Health Policy at University of Melbourne

Allen J Frances

Allen J Frances

Professor and chairman emeritus at Duke University School of Medicine

Patricia Gabow MD

Patricia Gabow MD

Former CEO of Denver Health and chair of the Lown Institute board of directors

Andrew GoldsteinMD, MPH

Andrew Goldstein
MD, MPH

Assistant professor at NYU School of Medicine and activist for global vaccine justice

Gregg Gonsalves

Gregg Gonsalves

Associate professor at Yale School of Public Health, Yale Law School

Merrill Goozner

Merrill Goozner

Creator of GoozNews and editor emeritus at Modern Healthcare

Mona Hanna-Attisha

Mona Hanna-Attisha

Assistant professor
at Michigan State University and Author of What the Eyes Don’t See

Paul Hattis

Paul Hattis

Senior fellow at the Lown Institute

Victor Montori

Victor Montori

Founder of The Patient Revolution and author of Why We Revolt

Casey Quinlan

Casey Quinlan

Founder of Mighty Casey Media, advisory board member of The Light Collective, and host of the Healthcare is HILARIOUS podcast

Reshma RamachandranMD, MPP

Reshma Ramachandran
MD, MPP

Yale National Clinician Scholars Program Fellow and board member of UAEM North America

Susan RogersMD

Susan Rogers
MD

President of Physicians for a National Health Program and retired internist at Cook County Hospital

Vikas Saini

Vikas Saini

President of the Lown Institute and co-chair of the Right Care Alliance

Gary Schwitzer

Gary Schwitzer

Publisher of HealthNewsReview.org and adjunct associate professor at University of Minnesota School of Public Health

John Sellers

John Sellers

Co-founder of The Other 98%