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

Discussion in 'Valeant Pharmaceuticals' started by anonymous, Nov 24, 2015 at 11:28 PM.

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  1. anonymous

    anonymous Guest

    There's I believe 17 class-action shareholder lawsuits and 1 insider trading one, thus far.

    The class action lawsuits are limited to minimum shareholder losses in the range of $100k, $250K or $1M from what I've seen. Hedge funds are eligible. One lawsuit I read said the firm plans on subpoenaing stock ownership records (and I assume they all will) and sending the holders that have lost hundreds of dollars or millions detailed letters stating: "Sign here, get your money back, mins our 30% cut!" (no work involved on your part). Do you think they're going to turn that down?

    Those are massive lawsuits. One firm stated the class could go into the tens of thousands.

    Hah. I wonder if Mike Pearson joins a class action law suit?
     
  2. anonymous

    anonymous Guest

    The insider trading one is particularly bad because if insider trading is proved then the illicit gains are immediately seized, plus punitive damages, which can range in multiples (ugh). In addition to jail time.

    Ackman made about $2B profit off his information from Michael J. Pearson. Do the math.
     
  3. anonymous

    anonymous Guest

    The one allegation I am curious about that I've seen contiinuously raised in multiple articles and again in the one posted above is:
    "Alleged fraudulent Philidor sales (e.g. altering prescriptions to specify Valeant branded drugs) could be considered an especially problematic form of phantom sales, worse than channel stuffing."

    The specialists that prescribed a prescription to Philidor did it with the permission of the patient because they knew what the specific price of that prescription would be for that specific Valeant drug and gave that information to the patient. So, its confusing when claims are made that they were "altering" prescriptions because the patient left the office knowing what prescription was written for them and that they were getting the prescription from a mail order specialty pharmacy different from their local one.

    Thats how specialty pharmacies work across the board. They put out a price list. They fax them to the offices. There's hundreds of them out there. The specialist offers the patient the option to go to a specialty pharmacy to get better pricing than their local retail pharmacy for a branded drug. Philidor offered contracted discounted pricing for Valeant prescriptions, specifically to my understanding.

    So, I guess my question about that allegation is, what would be the point of a dermatologist/podiatrist/other specialist sending a generic or another prescription to a specialty pharmacy, and not just sending that patient to their local pharmacy?

    So why and how would Philidor even have the option or need to change/alter any prescriptions to Valeant medications?

    Doctors who knew about Philidor, knew about Philidor because of the Valeant and Philidor representatives, for the most part. I am confused on why Philidor would've had other prescriptions there to change to Valeant prescriptions and what wouldve been the driving factor for that, I guess. I've seen several places and heard multiple times that 90% of the prescriptions coming to Philidor were Valeant prescriptions. So, what were they altering?

    I am not defending anything that is going on there. I have no idea on the specific details, and I think during all of the investigations time will tell what was or wasnt going on there. And I look forward to seeing what that is. I am so saddened for any employees at Philidor and/or Valeant that may lose or already have lost their jobs around the holiday season, especially those who were blind to all of this.

    However, I just am confused about that one detail, because it keeps being raised.
     
  4. Not a dump question to ask about whether changing scripts bad because doctors were explicitly sending patients to Philidor to get specific drugs. The answer is because unless the prescription is specifically written in a certain way, the pharmacist is, depending on the payer, supposed to take certain actions to replace or recommend lower cost or more effective replacement drugs to the patient. If the doctor writes "Dispense As Written" or "DAW" there are codes which go with it. Depending on what is written, the PBM can (depending on the payer plan) ask the pharmacist to substitute. If the prescribing doctor had not specified, and someone at Philidor writes in DAW 1, this means the pharmacist 'must' prescribe the drug specified as 'medically necessary'. If it is DAW0 or DAW with nothing, then if the payer/PBM says 'no reimbursement' because not 'medically necessary' and that plan doesn't support Jublia unless medically necessary, then Philidor person hangs up, scribbles DAW1 on the plan, routes it to another pharmacy 'affiliate', and says 'medically necessary' and the payer system spits back a price reject, so then they go testing prices.

    The pharmacist changing the DAW code is against the rules.

    http://www.pharmacy-tech-resources.com/Dispense-As-Written-Codes.html
     
  5. anonymous

    anonymous Guest


    The most obvious conflict of interest would be to alter the prescription when it does not contain a do not substitute specification. Many PBM contracts only cover generics unless the doctor specifies do not substitute, so Philidor would in this instance alter the prescription to specify do not substitute even though the doctor did not place such a limitation on the prescription.
     
  6. anonymous

    anonymous Guest

    This is crazy stuff. I'm a Valeant employee and this is crazy shit to me.
     
  7. anonymous

    anonymous Guest

    So....Posting a follow up from my original question.

    The doctor sent that drug to the specialty pharmacy that Valeant contracts pricing with, with a copay card for that branded drug. (this applies to any specialty pharmacy with any drug or any drug company) Clearly were still dealing with PBMs and pharmacy rules and prescription rules here because all rules apply because they still are in fact a pharmacy, but thinking about this as the patient and/or doctor.

    If I wrote a prescription for Jublia (because it was mentioned in an above post.)
    And I know that at this specialty pharmacy (Philidor) that the patient could get a specific price because I hand them this copay card. And this company (Valeant) has contracted pricing with them.
    And if not Philidor I have 8 other specialty pharmacies who have faxed me pricing and offered me the exact same price for this patient, with no question of which PBM they have
    None of them told me as a doctor to write DAW on the script when I fax or over or Escribe it though in order to guarantee that price to the patient or to get it covered.

    However, my assumption as a physician would be I wrote a prescription to a specialty pharmacy that asked me to send them a Jublia prescription and gave me copay cards for the patient and put in print that this is the set price for patients. They ought to honor that price for patients. Period. And in my experience that is what has happened.

    If as the doctor I wanted that drug to be substituted to a generic why in the world would I send it to a specialty pharmacy in the first place? Because the retail pharmacies will do that all day long. And do. And will send the office a prior authorization and deny the branded medication anyway. So then not only did I waste my time, my office staff's time and my resources to deal with all of that. My patient still didn't get the drug I tried to prescribed in the first place, so now I have an angry or at the very least untreated patient, or a patient that left with samples of the drug I prescribed for them and are actually using at home the drug that the pharmacist chose for them at one of the retail chains. Or their PBM chose for them.

    It's not like as the doctor, they had to offer the option of a specialty pharmacy to the patient. Or had to Escribe the prescription there. They don't. They don't have to chose a branded drug. They can write a generic.

    That's another question I would pose in all of this. What percentage of prescriptions are being electonically written now? And what was that percentage through Philidor versus faxed paper prescriptions. I guarantee it is a very very large percentage based on all of the current changes that took place on October 1. A large majority of doctors offices transitioned a long time ago for that.
    So, How would a pharmacist from one pharmacy (say Philidor) scribbling DAW or DAW1 or DAW0 on an e-scribed prescription and transferring it to another partner pharmacy?

    I guess that was the point of my question.
     
  8. anonymous

    anonymous Guest

    To follow up with my above post... I am not defending Philidor in any way shape or form especially if they were altering prescriptions. Or doing anything fraudulent for that matter. That is wrong. Shouldn't happen.
    And if it did they should and will pay the consequences for that. Whoever they is.

    My question to it was more the why? The how? What is the point of sending a script to a specialty pharmacy? And I don't know that a doctor would think they need to write DAW on a script going to a specialty pharmacy. Just throwing that out there.

    And that if we are making a big point of this especially on the cafepharma discussion board.... Meaning most of us on here work in the industry and aren't just trying to screw Valeant and Philidor over by exposing more and more crap about them because they will get what's coming to them.

    We probably should look at the bigger picture here. Why is all of this happening? Why are all of the Pharma companies seeking out speciality pharmacies?
     
  9. anonymous

    anonymous Guest

    Why are there employees still defending Valeant. Altering anything with a licensed health care provider's signature on it is flat out illegal. Any other would be fined over $100,000 for this if caught at the pharmacy and spends 5+ years in jail. These are white collar criminals and anyone who were supposed to know should be thrown in jail. It's their job to know. Throw their asses in jail and let them pay the time like everyone else who commits a crime.
     
  10. anonymous

    anonymous Guest

    Pharmacists make substitutions like this every day at almost every pharmacy...it doesn't mean that it's right - but it happens ...
     
  11. anonymous

    anonymous Guest

    Do they substitute the $30 drug for the $700 drug?

    PBMs/Payers audit pharmacies. When the pharmacy has bad practices, they cut them off. Like the big PBMs did with Philidor. So Philidor did an end-run (and John Hempton argues may still be doing one).

    I would say that as long as Philidor is doing its OWN end-run, not managed by Valeant any more, then the truth will out. If I were them and I wanted to restart the charade, I would cut everything down, take a 3-month break, play lots of golf, switch the naming regime to famous historical figures in the respective locality, and I'd aim low. If this "re-routing" which has been done is OK if you own your own network, then just set up 1-2 "community pharmacies" in each state, run it as a Philidor-style business. Run 3-4 pharmaceutical companies' products through it. Just make sure that none of them are in competing areas. One for derma, one for neuro, one for ophthalmology, one for XYZ. That way each pharmaceutical company happy not competing in their space and payers see pharmacies prescribing multiple pharmas' items.
     
  12. anonymous

    anonymous Guest

    That's not true. Pharmacists can make substitutions (depending on the state regs) if there's a therapeutically equivalent generic without needing to contact the provider/staff. This is legal in most states. Pharmacists, however, cannot and DO NOT go about altering scripts such as writing 'DAW', adding refills and whatever else Valeant instructed Philidor to do. If this occurred in my home state, the FBI would raid that pharmacy and put any and everyone involved behind bars. No questions asked. Most doctors do not write 'DAW' unless it's absolutely critical or the patient has a critical condition or severe allergic reaction. I'm just hoping docs are not seeing or looking at this shit online.
     
  13. anonymous

    anonymous Guest

    The "damage control" crew on here is hilarious.

    Writing "DAW" on a Rx from a Doctor is altering a doctor's Rx, which constitutes A FEDERAL FELONY, in addition to MULTIPLE FEDERAL FELONIES.

    It isn't a fucking "oh it's no big deal". The feds will fucking raid a pharmacy and tear it apart if they get a report that any Rx fraud is going on there.

    First off, it's not just fucking "DAW" mods. It's changing diagnoses to get a script filled (federal felony, ie. toe fungus would almost never result in an insurer paying out $1000/week for "Jublia" (with 15% efficacy over ~
    40 weeks, Vicks Vapo-o-rub is more effective) vs $20 for a generic, but a sarcoma of the toes/feet/skin/etc would justify that (ie. if they didn't prescribe it given the diagnosis, they could be sued to high hell).

    To those that can't follow.

    Doctor to Patient: "Oh, you have Toe fungus, I'll write you Jublia, which is the brand name, but you can get the generic, a efinaconazole topical, for $20, so go with that, here you go. Best of luck"

    Patient to Pharmacist: "Hi, ok, so $1000 for Jublia, or $20 for the generic? I'll go with the generic."

    Pharmacist to patient: "But wait, did you know there is a specialty pharmacy with coupons so you pay $0?"

    Patient to Pharmacist: "Oh, so I save $20? Ok!"

    Patient calls up Philidor and forwards the Rx.

    .......... meanwhile ..........

    Philidor to PBM: "Hi we have a patient here that need Jublia at $1000/week for 40 weeks"

    PBM to Philidor: "Wait a second, we shitlisted you a long time ago for ripping us off, wtf?"

    Philidor to PBM: "Sorry, R&O Pharmacy this is."

    PBM To Philidor: "We shitlisted that one too as all it billed was Valeant products."

    Philidor to PBM: "Oh sorry, AB827A8918 Pharmacy in Snowdon Utah, population 240."

    PBM To Philidor: "Hrm, ok, the NPI is finally accepted. What was the condition and prescription?"

    Philidor to PBM: "Toe fungus. Jublia."

    PBM to Philidor: "Sorry, our formulary strictly stipulates that toe fungus is treated with the generic. We refuse your request for Jublia @ $1000/vial vs the generic @ $20."

    Philidor to PBM: "The doctor wrote "DISEPENSE AS WRITTEN". Ok? FILL IT NOW!"

    PBM to Philidor: "Sorry, we do not pay $1000/vial for toe fungus."

    Philidor to PBM: "Whoops, sorry, it's Stage 4 toe sarcoma. We have a huge legal staff in case you dont fill this Rx."
     
  14. anonymous

    anonymous Guest

    Can any pharmacists confirm?
     
  15. anonymous

    anonymous Guest

    Very true. If Valeant/Philidor altered RX's then the pharmacist filled these and dispensed the scripts (Pharmacist's name and date would be noted on the actual script and in electronic record) would very much so get their license taken away. If one particular pharmacist did this on their own usually the DEA is involved and they strip the pharmacist of their license then place the pharmacist under arrest since this IS a federal crime.

    Now, if all or most pharmacists practiced this way and this is how the Philidor operated, then these are far more serious federal crimes against Valeant and Philidor. Far more serious which usually involves the DEA locking up those involved for years at a time.

    I'm surprised Valeant and Philidor are still operating. The Feds should revoke their business to practice in the US until they are cleared of allegations. Happens when smaller businesses are hit with serious allegations so why not Valeant??
     
  16. anonymous

    anonymous Guest

    I love how no one knows what they're talking about. Drs ONLY used Philidor to get the brand. I love how everyone seems to think the insurance companies know the best medications from a whats he CHEAPest drug not whats the best drug book. The dr is the one that writes the script and the insurance companies are changing it. Since when did these payers, who we as patients pay thousands, get to switch to what they want? You all have this backwards. I go to the dr to get a prescription because he went to med school. I guess it would be easier to FaceTime a customer service rep at blue cross blue shield and have them diagnose me and send in a script....
     
  17. anonymous

    anonymous Guest

    Holy s**t, if they were writting DAW on scripts it is a very big deal. I'll be standing by, popcorn ready, waiting for the fireworks.

    I spoke to someone I know that had one of VRX's products written for them and he told me they literally had to call them and demand they stop sending product. They kept automatically sending them product without even a phone call. In a no co-pay world they can get away with this because people aren't paying immediate out of pocket costs.

    This whole thing is a fascinating story......
     
  18. anonymous

    anonymous Guest

    Like someone above said, suspend Valeant, Philidor or any subsidiary pharmacies their business license and review the records at Philidor. Hopefully Valeant hasn't rid the records yet. And I do believe Valeant was behind all this. I'm a resident of PA and live near the town of many Philidor employees that were laid off. We are trying to spread the word to any and everyone to not use any Valeant product!!
     
  19. This is the potential fraud. Not the "accounting fraud" claimed by Andrew Left or the channel stuffing in Slovenia.
    • Valeant and Philidor can always claim "someone ticked the wrong box by mistake and it was sent that way... yes we realize this inconveniences people - we'll put in safeguards so that it doesn't happen again... we're so remorseful.... blah blah blah."
    • The smoking gun is when someone was told to do that on purpose. That requires people to talk, or manuals to get out, or email traffic.
    • All this talk around here of people having stuff shredded and not being allowed to take copies of training manuals, etc, tells me that there IS something wrong. Nobody needs anything shredded in a call center except for customer confidential information. Taking away copies of NPI numbers when you can get them off the net just signals there is something wrong.
    The change in business paradigm short angle has always been about whether Valeant built Philidor and kept it (officially) at arms' length in order to perpetrate excess consumption (and therefore excess reimbursement) through a) offering zero co-pays to induce a "well if it's free I'll take it" when in fact it is not free because you pay your insurer higher costs next year, b) sending patients to Philidor where the PIC cannot sell you a cheaper alternative because he doesn't have one, c) inducing the doctor to provide a DAW1 (through giving him zero co-pay coupons which make him/her look good to patients?) so that it has to be prescribed, d) unsolicited auto-refills which cause excess 'consumption' - Jublia is perfect because it is a 12-month treatment - if the insurer signs off at $500, then free refills all the way. If the insurer signs off on $200, then you get the patient to pay a $50 co-pay. If the insurer signs off on $350, give him a $35 co-pay.

    The co-pay changes, if done through Medicaid/Medicare is patently illegal. The co-pay changes done through private paying insurance is very, very gray. The insurance contract is not between insurer and pharmacy, PBM, or pharmacy mfr but between the insured and the insurer. If the insured has a 10% co-pay agreement, and he gets Jublia co-pay knocked down to $1, then the insurer pays $9. Doing so otherwise could be considered to be insurance fraud.

    Having a pharmacy do that 23,000 times a day resembles racketeering.

    The big story here is not the secrets. The big story here is WHY the secrets. Mike Pearson's comment that "we believe that our alternative fulfillment programs are a competitive advantage" isn't that they are competing against terbinafine. They are competing against the PBMs and payers.