Philidor's Alleged Altering Of Prescriptions Could Mean Multi-Billion Dollar Liabilities For Valeant

Valeant employee here....

One of the people on here explained what was allegedly going on behind the scenes at Philidor when a doctor wrote a prescription using Jublia as an example.
First, his or her example was extremely eye opening on my end and I'm sure for a lot of my other colleagues reading if it even has an ounce of truth. As reps we were told... $0 copay for covered / commercially insured patients, $75 copay for cash paying patients (dumbing it down lots of fine print on the back of the rebate card). They fax the prior authorization to the office, and get it covered for the patient, if not, they bill the difference to Valeant. That's it... that’s all we knew/know, as reps. And this was an OPTION for the Doctors and the Patients. Retail pharmacies or other specialty pharmacies always were an option. Even though in his example he or she said Jublia for Toe Sarcoma which Jublia would do absolutely nothing for, I get the point he or she was trying to make. DAW is on there and fill the script or we will put lawyers on you. However, I have to say, he or she discussed a lot of information which was untrue regarding efficacy and vicks vapor rub and he needs to check his facts regarding why patients wouldn't be candidates for the available generics.


I think the post I quoted above in combination with the one that I referenced walking through the Philidor/PBM conversations sums up why none of this has been confirmed by the government yet. If there are as many pharmacies, license numbers, and DEA numbers as theguys on here have uncovered, it will take YEARS to figure all of this out. A Federal investigation takes that long anyway.


The Valeant Reps had NO idea about any of that part of the back end of Philidor. Maybe that was by design? We didn't even know the DAW part. Had we known that a doctor needed to write DAW on the prescription to get it covered, it may have been just as easy to continue going to retail pharmacies and do the same thing?


We thought the Prior Authorizations that were sent back to the office got the prescription covered (or not) for the patient, or that Valeant was paying for the prescription via the coupon card as it would at any retail pharmacy for commercially insured patient. While everyone else was paying the cash price offered by Philidor. The alleged explanation of what was going on is truly shocking and sickening, if it has any remote truth. All the while, we thought we were bringing an easier solution to offices and patients to get the prescriptions they prescribed at an affordable cost in the hands of their patients. My thoughts on why the operations at Philidor haven’t been shut down is because whether or not things were going on the way they should or shouldn't have, there are still a lot of patients getting medications there... wherever "there" is, and regardless of all of that, this obligation still stands to the doctors’ offices and to the patients. Likewise, no insurance claims are getting run through currently, so none of those alleged processes discussed are possible currently.


I do hope that the reason MP decided to cut ties with Philidor when all of this came out is because he was blind to it, but based on a lot of the things I've read here... that is hard to believe.

I think the people who are saying that the "damage control" crew is on here are missing the point of what is being said. Doctors wouldn't utilize a specialty pharmacy if they didn’t want a specific branded medication and their patients to get that specific branded medication. That’s the only point. In no way shape or form would I, nor do I think any of the salespeople I know personally at the company, condone, nor would even talk about a specialty pharmacy, if they knew that pharmacy was committing fraud or doing anything remotely illegal or illegitimate. Our careers and personal reputations are on the line here too. So call it what you will.. damage control or what... No one from Valeant has said, nor do I think anyone would say, "Its okay for a pharmacy tech, or pharmacist to write 'DAW' for the doctor because thats what they wanted anyway". The point that was being made was they wouldn't have sent it to the pharmacy if they didnt want that medication. And that the Valeant employees had no idea this was being done because we thought the patients were getting the medication because of either a prior authorization was done by the office or because of the coupon card buying down the cost of the medication, just as it would at a retail pharmacy. We had no idea this stuff was going on, on the backend.


Just thought I would put my two cents in.

 

Thanks to the above poster for stepping in.
The biggest issue the healthcare system has is that there are no checks and balances. Everyone involved benefits from costs going up EXCEPT the quality of life of the patients. Costs are higher in the US than basically anywhere else for most all aspects of healthcare.

Check http://www.compareyourcountry.org/health?cr=oecd&cr1=oecd&lg=en&page=2

Check the International Federation of Health Plans 2013 Pricing Report referenced on a SA post a short while ago. Costs are simply higher (the OECD page I know has an Excel spreadsheet which shows the costs per capita and GDP over time per country. Not pretty.

The goal of every medical treatment offered by a pharmaceutical company is to make money off it. This is understood. What you have to think about is the incentives. If Michael Pearson gets a stupid number of shares, then that number triples if the stock goes up 30% a year, year after year (which is way in excess of industry growth), is that really OK? The poster on SA had a point. What if EVERY CEO was like that? Didn't everyone get really P.O.ed at bankers a few years ago precisely because the incentives were perverse and the growth in the industry's profits did not benefit the users of the service?

 

Thanks to the rep from Valeant for a great insight and summary of "a day in the life" of a Valeant rep.
After reading the Philidor conversation it popped in my head that this was a totally planned out process from the beginning at Philidor. Things moved way to fast at Philidor for many of the processes to have just evolved the main road block with Prior Auth hadto have had a solution prior to Philidor opening it's doors! Everything else followed suit.

 

How are you a drug rep and not know what 'DAW' means?? DAW is not something only a Valeant/Philidor thing, but during training for any drug company, this is taught and when discussing managed care for your territory, you are told a million times to sell 'DAW' to your doctors every other day by your manager. Here at Valeant, this was explained repeatedly by whomever your Valeant Access Manager. You had weekly and sometimes twice a week conference calls regarding Philidor and how to detail and push Philidor down the doctors' throat.

I don't buy you didn't know what 'DAW' is/was. Be honest… we were all reprimanded if we didn't sell Philidor on every single call. I'm sure every rep in this company pushed their docs to write DAW to all their docs, and we all knew why it was mandatory to do so. Your defense doesn't add up.

Your statement of "Had we known that a doctor needed to write DAW on the prescription to get it covered, it may have been just as easy to continue going to retail pharmacies and do the same thing?".. You knew darn well the pharmacist will do any and everything they can to not fill your branded product regardless if DAW was written or checked off on the script a hundred times. Quit trolling.. your post sounds bogus as hell.

 

Philidor recorded every phone call between them and the patient.

 

http://www.jabfm.org/content/24/1/69.full
...(27.8%) had a mycological cure with Vicks

Now..... Do you want me to fact check Jublia's cure rate?

 

18 patients in the study! Hahahahaha! Go somewhere else. Can't believe you would even post something like this to prove your point. Don't make me break it down for you to prove how ridiculous this is!

 

The only more ridiculous study is the one done for the FDA approval on Addyi: 25 healthy volunteers for a sexual arousal drug that is only medically prescribed to women--- except Sprout ran the study using 23 male subjects and 2 female!

Way to rig the results, Pearson/Whitehead/Ackman! The Bermuda Triangle of Pharmaceutical Ethics!

(Pssssst, Pearson: don't forget you have another $500-Million payment due to the Whiteheads and Ackman next quarter. Might be time to hit the Revolver again.)

 

I appreciate you saying I'm trolling, but I've been with Valeant for some time now. I'm not sure which part of what I said made you think I didn't know what DAW means, but dispense as written has been on script pads, or a box to be checked in the emr system for a very long time, and I have had to go that route for all of the other products/launches I've sold over the years.

I had 80%+ of the prescriptions in my territory going through Philidor once I presented the OPTION to my customers and never once did I ask my doctors to write DAW on their prescriptions, nor did I direct traffic to Philidor.

However, I think you missed the point of what I was saying entirely.

Why would a doctor need to write DAW in the first place for a specialty pharmacy? Or at the very least, would a doctor make that assumption on their own? Because if not, they would just use retail and write DAW. It's the same thing. The point of my post was, if the pharmacists were forging DAW on a prescription in my territory to get things covered... I as a rep had NO idea about it, and I would have never once discussed Philidor in any of my offices if it were the case, and I would've quit forever ago.
I wasn't on here to get attacked by a coworker. I just kept seeing people assuming (on CP and in the media) that we as reps and managers knew what was going on behind the scenes at Philidor. And I definitely didn't. And if you (or anyone else) did, and kept presenting that as option anyway, then I think it says a lot about why there are so many questions about the ethical nature of our company right now.

It is illegal to direct traffic to a pharmacy. On the reps behalf, the doctors behalf, the pharmaceutical companies behalf. None of them are allowed to do it.
It's an option.
And so, it was always presented as an option on my part. Just as I did in my original post. And the doctors that had issues getting my products covered, that chose to utilize a specialty pharmacy instead of the retail pharmacies, did that by choice and it was a decision made by them and their patients. And they knew that the pharmacy around the corner is always an option as well.

DAW wasn't ever discussed on my behalf because it wasn't necessary if they were utilizing Philidor, so I thought, and I was under the impression when a prescription required a prior authorization to get it covered it was faxed to the office and required the doctors signature and sent back to Philidor.

So, no BS here. That's what was going on in my area. Clearly we don't operate in the same district and most likely not even in the same region, considering the vastly different direction. But best of luck to you during this crazy time. It hasn't been easy at all. Morale has sucked. Offices don't know what the hell to think and we're just supposed to slap a smile on and be cheery and sunshiny. So, I apologize for our misunderstanding, but good luck to you out there, and Happy Holidays.

 

'DAW wasn't ever discussed on my behalf because it wasn't necessary if they were utilizing Philidor, so I thought, and I was under the impression when a prescription required a prior authorization to get it covered it was faxed to the office and required the doctors signature and sent back to Philidor.'

I think this is a good example of how screwed up the US healthcare system is. Docs don't know how much drugs cost when they prescribe, and patients think about whether or not they can afford their co-pay and don't see the information on actual cost. If patients were presented with 'I can give you solodyne, which costs your insurance company $1,000 or I can give you a similar generic which you take twice a day and costs $30' they might start to think about costs and premium increases. Docs might think 'insurers continue to squeeze me on what I can charge. maybe it's in my best interest to consider price if there is an equally good drug that's less expensive. There's only so much money in the system and right now patients and non-hospital doctors have the least leverage.'
Drug reps can only sell what they're given but if incentives in the overall system were better aligned then maybe pharmcos would focus more on innovation and drugs with differentiated value and less on gaming the system.
The US has accepted the 'shrouded system to support innovation' but it's led to hedge-fund sharks who are making money at the public's expense.

 

Very well said!!! Hedge fund sharks and Wall Street need to get out of health care. It would clean up so much corporate corruption and maybe actually save people's lives instead of make corporate execs even richer!

 

Regarding post number 21 and 29. Your coworkers arent attacking you, were calling you out. Only an arrongant POS "dumbs down" the fine print on the copay cards to his colleagues. We watched you sleep you way through Memphis then transfer to Nashville on the pretense that you were marrying a medical professional. We all knew it was a lie. Valeant likes liars, that why you made every single cut. You knew exactly what was going on with Philador. "No BS here" is complete horse dung.

 

Quit the BS. I don't work at Valeant but have invested time, money on your company and know a few key things from investigator calls and investigation reports. It seems the reps knew exactly what was going on and so did your DM and RM. 'I had no idea' doesn't play out in court well under any circumstance. I hope the courts subpoenas all conference calls from this garbage of a pharmaceutical company. It was brought up during the investigation that conference calls between district managers to reps that DMs continued to encourage reps to push Philidor to doctors allowing no other option for different pharmacies despite being under investigation. The entire company is a fraud including reps. I hope the reps and DM s are called to testify throughout all this. Maybe you liars will then learn your lesson then and be forever banned from working in any health care sector. It is to my understanding also that reps were encouraging offices to opt out of utilizing their Medicare or Medicaid insurance and instead have patients say they are cash pay to the Philidor customer agent. But let me guess, you didn't know this was illegal too. I hope you all get what you deserve and this company runs to the ground.