Pharmaceutical company messed with the wrong YouTuber

January 25, 2011 12:52 PM

Well, that's one way to use your Youtube audience. Hank Green, one half of the VlogBrothers, is angry at Warner Chilcott, the pharmaceutical company responsible for Asacol--a drug that's gone up in price by 1200%. He's so angry, in fact, that he encourages his nearly half-million-strong YouTube audience to spam Warner Chilcott's CEO, Roger Boissonneault.
posted by litnerd (38 comments total)

Why doesn't he just switch back to Apriso? I suppose that wouldn't be a very interesting video, just him getting a new RX from his doctor and taking a trip to the pharmacy. He's lucky that there are two competing brands and three (?) products that treat his condition: Apriso, Asacol, Asacol HD. If he really wants to stick it to Warner Chilcott, go with the competing cheaper product.
posted by 2bucksplus at 1:18 PM on January 25, 2011

To be fair, Hank asked them to be civil and argue the case to the CEO. He didn't ask them to spam him (although, I suspect that's what may happen).
posted by chrisamiller at 1:21 PM on January 25, 2011 [2 favorites]

Maybe they'll get lots of messages with their own product name misspelled. Because that's a way to have your message stand out!
posted by msbutah at 1:21 PM on January 25, 2011 [2 favorites]

Why don't we all sit around here on the internet criticizing this guy for criticizing a drug company for price gouging on a necessary medicine.
posted by Threeway Handshake at 1:36 PM on January 25, 2011 [10 favorites]

I'm totally not criticizing Hank Green. I love Hank Green. I'm a nerdfighter. I'm just noting that this CEO will get spammed, even if the emails are intelligent.
posted by litnerd at 1:43 PM on January 25, 2011

He deserves to be spammed for not having a savvy enough PR team - Asacol is a drug used for colon inflammation. As are Pentasa, Azasan and Colazal. I cannot be the only one who finds this completely hilarious.
posted by 8dot3 at 1:50 PM on January 25, 2011 [3 favorites]

Is a side effect of his medication that he bounces around like a gnat for 4 minutes?

Seriously, this stunt won't do shit for Warner Chilcot. If the CEO even has access to that address, he'd quickly get an assistant or the IT department to spaminate the teeming millions. The CEO may be annoyed for 5 minutes, tops. I doubt this will be like when the guy complained about United losing his guitar. Pharmas customers are doctors and insurance companies. We need the medicine, but fuck us.

Like 2buckplus said, it would be better to switch to the competing brand and tell his fans with his condition to do the same. It won't make the price go down, but it will make people feel better they aren't putting up with the price gouging.
posted by birdherder at 1:52 PM on January 25, 2011

So, I've looked around and I didn't see anything obvious; is there a reason the cost of the drug went up that much? Like, is it made from unicorn tears and the unicorns all ran away or something? Because that's an absurd jump in cost.
posted by quin at 2:00 PM on January 25, 2011 [2 favorites]

It's made of hens' teeth, dude.
posted by Mister_A at 2:07 PM on January 25, 2011

is there a reason the cost of the drug went up that much?

Hank Green briefly showed his (nearly expired) coupon card, which reduces the co-pay hit from hundreds of dollars to $50 per fill. These cards are issued by the drug manufacturers to drive fills of non-generic prescriptions.

Insurance companies hate these cards, because the coupons raise insurer costs and hide costs from the patient. Drug companies love these cards, because patients use them to get brand-name drugs, driving profits.

Patients and doctors love them because, in theory, non-generics are more likely to work better than generics. In most cases, generics work just as well as brand-name equivalents. But marketing is a big driver of profits and the coupon cards work to that end.

Pharmas can get away with raising the cost of brand-name drugs, if customers can be insulated from co-pay costs. Of course, this indirectly raises premiums for everyone, but the effects are delayed and the cause is not immediately obvious in these discussions.

There's a good NYT article that discusses the issues around this.
posted by Blazecock Pileon at 2:22 PM on January 25, 2011 [8 favorites]

He should get 4chan to do a DDOS and take down the company website... put out an ominous video, then take out all related company websites, and then some unrelated company websites...
posted by greenhornet at 2:23 PM on January 25, 2011

It would be an interesting effect of the increase of social media if companies would treat each costumer like they would treat their most famous or influential one.
posted by charles kaapjes at 2:24 PM on January 25, 2011

He's lucky that there are two competing brands and three (?) products that treat his condition: Apriso, Asacol, Asacol HD. If he really wants to stick it to Warner Chilcott, go with the competing cheaper product.

There are actually several dozen -- from ancient sulfa drugs to medical marijuana. Some patients go through every available medication and therapy, and find that this is the only one that puts them in remission; even other 5-ASA drugs don't have the same delivery mechanism and dosage (the two others you listed are delayed-release, for example). Just because there are multiple things that CAN treat a disease doesn't mean all treatment options work the same for everyone, or that it's easy or safe to switch between them.

This is why people are outraged, and have every right to be -- it's not as cut-and-dry as "voting with your wallet", it's that people will have to "test-run" an unproven medication that may or may not treat a disease that causes DAILY ASS BLEEDING... simply because the manufacturer decided to be all "surprise! 10x price hike! LOL!!!"
posted by jake at 2:25 PM on January 25, 2011 [16 favorites]

greenhornet: "He should get 4chan to do a DDOS and take down the company website... put out an ominous video, then take out all related company websites, and then some unrelated company websites..."

"Message to the church of Pharmacology"...
posted by symbioid at 2:25 PM on January 25, 2011

Damitol to hell.
posted by Ratio at 2:30 PM on January 25, 2011 [2 favorites]

Hank has said in previous videos that this is the *only* medication that works for him.
posted by tzikeh at 2:32 PM on January 25, 2011

I cannot be the only one who finds this completely hilarious.

Oh man, I LIVE for the beginning of each month, when I can stroll briskly into the pharmacy and announce "I'M HERE TO REFILL MY ASSSSSSACOL". Because laughing helps you avoid crying.
posted by jake at 2:38 PM on January 25, 2011

What 2buckplus said. This is not a brand new product that is unique in all the world. The Wikipedia page lists six different brands available in the US. There's got to be more going on here, because charging $180 for a pizza while all the other pizza places in town are charging $15 is not going to get you very far.
posted by Kid Charlemagne at 2:38 PM on January 25, 2011

From Blazecock Pileon's link:

Last month, for instance, Pfizer introduced a new card that can reduce the co-pay on its blockbuster drug Lipitor to $4 a month, a savings of up to $50. That brings the out-of-pocket cost in line with what consumers might pay at Wal-Mart for a generic version of a competing cholesterol-lowering drug.

Ok, maybe I'm just being exceptionally obtuse, but if the drug companies themselves are subsidizing the cost of these cards, doesn't that suggest that the overall cost of the drug is artificially high? I mean, if they can afford to give it away at a fraction of their "cost" for an extended period of time to keep people from going to similarly inexpensive generics, and still remain profitable, isn't that a pretty clear example of the market saying that that's what that drug should cost?

Subsidizing it long enough to get people committed to it and then eliminating the cost reducing card smacks me exactly as a dealer with "the first one's free" kind of pusher mentality.
posted by quin at 2:41 PM on January 25, 2011 [2 favorites]

Subsidizing it long enough to get people committed to it and then eliminating the cost reducing card smacks me exactly as a dealer with "the first one's free" kind of pusher mentality.

I don't disagree. In a better world, we'd have single-payer insurance, cost controls, and rational limits on patent extensions. I don't know if this YouTube video does much to help get us there, but maybe it will help get the discussion started for some people.
posted by Blazecock Pileon at 2:53 PM on January 25, 2011 [1 favorite]

quin: Ok, maybe I'm just being exceptionally obtuse, but if the drug companies themselves are subsidizing the cost of these cards, doesn't that suggest that the overall cost of the drug is artificially high?

From the article, Big Pharma is subsidizing the cost of the co-payment, which is generally a fraction of end-user cost of the drug. They're providing an incentive for people to switch from a low-cost generic to a high-cost name-brand. If someone with insurance pays a $30 co-pay on a generic medication, but $40 for the name-brand, and now they get a $20 discount card from Big Pharma, they'll switch to the $20 medication. On the back end, the insurance company pays $100 for the Brand Name, but only $30 for the generic. Big Pharma went from getting nothing, to getting $120 (versus the possible $140, prior to their $20-off card).
posted by filthy light thief at 2:55 PM on January 25, 2011 [6 favorites]

My State AG is suing to overturn Obamacare while the drug companies are ripping us off. I hate this.
posted by humanfont at 3:00 PM on January 25, 2011 [3 favorites]

quin: Ok, maybe I'm just being exceptionally obtuse, but if the drug companies themselves are subsidizing the cost of these cards, doesn't that suggest that the overall cost of the drug is artificially high?

Without any shadow of a doubt. Though drug companies will argue that since so much of their cost is in R&D rather than production, it's very hard to nail down the math of how much the cost of the drug should be.

For example: if it cost $1M to develop a new drug, and $1 to manufacture a prescription for it, how much should you charge for it? You can't really know the answer to that question without some idea of how many people will buy it, and how much they'll be willing to pay... So it's purely a business decision.

This is further complicated by the fact that the patient doesn't really pay anything linearly related to what the insurance company pays, though the insurance company will raise your copay to dissuade you from buying expensive drugs when there's a suitable (in their view) generic alternative (the $50 card was the drug company's way of trying to squash that copay disincentive)

And all this is still more complicated by the fact that your doctor very likely will prescribe and recommend the "best drug" in her opinion (whatever that opinion is based on), regardless of what it costs, because she is the doctor and that's her job--to recommend the best treatment.

So the running pattern is:
1) doctor prescribes overly expensive drug
2) insurance pays overly expensive cost
3) everybody's premiums go up
4) repeat!

God, I hate American Healthcare.
posted by georgikeith at 3:32 PM on January 25, 2011 [1 favorite]

And all this is still more complicated by the fact that your doctor very likely will prescribe and recommend the "best drug" in her opinion (whatever that opinion is based on)

Free trips, cute ex-cheerleader salesmodels handing out samples, trinkets and payments to doctors and doctor organizations, are a few of the things that opinion might be based on:

In a New York Times article, a whistleblower described how the manufacturer of Neurontin, a drug for epilepsy, promoted the drug for unapproved uses, making Neurontin a multi-billion dollar success. The company's strategy included paying doctors to pose as authors of articles actually written by non-medical employees of the manufacturer. The company paid hundreds of doctors to attend expensive dinners and weekend retreats where speakers urged the use of Neurontin for off-label purposes. Doctors prescribing Neurontin were paid to encourage other physicians to do the same. Doctors were paid to enlist patients in clinical trials of Neurontin that were designed mainly for marketing purposes.7

This wasn't an isolated incident. The Wall Street Journal reported:

"Biovail Corp., a large Canadian drug company, has been paying as much as $1,000 each to thousands of doctors in the U.S. prescribing the company's new heart medication. ... The strategy, part of Biovail's effort to launch a medicine called Cardizem LA, underscores how some companies aggressively market their drugs to doctors. ... And some heart specialists say the Biovail is no more effective than much-cheaper generic versions of a similar drug."

Biovail's marketing strategy was very successful because it not only paid doctors, but also office managers to help push its product. And, of course, Biovail did not require doctors to inform patients of the compensation they received.
posted by mediareport at 4:10 PM on January 25, 2011

Having the public write individual, personalized emails in complaint to a CEO is not spamming. Period. At best it could be called lobbying, something the companies both approve of and heartily endorse. They can afford an intern to go delete them all if they object.
posted by Bovine Love at 4:14 PM on January 25, 2011

Stupid question from a Canadian: Why don't the insurance companies refuse to purchase the 'genuine' drug if an generic is available? Or only pay up to the generic price?
posted by Bovine Love at 4:20 PM on January 25, 2011

Asacol is a drug used for colon inflammation. I cannot be the only one who finds this completely hilarious.

HAHAH! Irritable Bowel Disease IS SO FUNNY! HAHAHA! I mean really, when I was bent over in unbelievable agony because my intestine was blocked because the stitches from my surgery to remove six inches of my intestine adhered to the other side of my intestine, I couldn't help but chuckle at the comic potential of the situation.
posted by waitingtoderail at 4:35 PM on January 25, 2011 [6 favorites]

HAHAH! Irritable Bowel Disease IS SO FUNNY! HAHAHA! I mean really, when I was bent over in unbelievable agony because my intestine was blocked because the stitches from my surgery to remove six inches of my intestine adhered to the other side of my intestine, I couldn't help but chuckle at the comic potential of the situation.

Inflammatory Bowel Disease is not funny.
Naming an IBD drug 'Asacol' is funny.
I think that's what 8dot3 meant.
posted by Ratio at 4:43 PM on January 25, 2011

Stupid question from a Canadian: Why don't the insurance companies refuse to purchase the 'genuine' drug if an generic is available?

They do. In fact, due to those policies combined with completely idiotic and paternalistic laws in some states, some people who know perfectly well that the generic not only doesn't work for them but makes life a living hell for them cannot buy the druga they need even if they are lucky enough to be able to pay the enormous markup. Me? Why, yes, why do you ask?
posted by The Bellman at 4:49 PM on January 25, 2011 [4 favorites]

druga = drugs. That's a rage typo not some Clockwork Orange Nadsat thing.
posted by The Bellman at 4:50 PM on January 25, 2011 [1 favorite]

OK, well, if I misinterpreted then I apologize.
posted by waitingtoderail at 4:52 PM on January 25, 2011

Stupid question from a Canadian: Why don't the insurance companies refuse to purchase the 'genuine' drug if an generic is available? Or only pay up to the generic price?

When we had insurance (sigh), the copay on my generic prescription was $10. If I wanted the "genuine" drug, it was $50. I've never heard of these coupon card things.
posted by desjardins at 5:08 PM on January 25, 2011

Gah, sorry. I didn't mean to trivialize anyone's literal IBD pain, I really was just making fun of the drug name. An ex of mine had crohn's disease and delightedly pointed out to me that two of his three prescriptions to manage the disease had the word 'ass' in the drug name. When he pointed it out to his doctor, the doc was 100% unamused.
posted by 8dot3 at 5:16 PM on January 25, 2011 [3 favorites]

part of medical insurance should be insurance against drug price hikes (say, mitigating them to a maximum of 10% per year.) That would incentivize the insurance companies to bargain with the drug companies. It would also eliminate behaviours like patients stockpiling medication — that's what the pharmacies are supposed to do.
posted by esprit de l'escalier at 8:32 PM on January 25, 2011

It doesn't sound like there was a price hike, it sounds like there was an introductory discount that ended. I can't get much outrage on about that. It sucks if the only drug that helps Hank is the really expensive one, but that fact wouldn't be altered by prohibiting discount cards.
posted by hattifattener at 11:58 PM on January 25, 2011

Somewhat unrelated, but drug-company-jerkiness related in a way:
If you're a drug company with a soon-to-expire patent on a profitable Old Drug, follow these easy guidelines to continued high profits:
1. develop time-release (or other minor tweak) version of the same drug; patent that New Drug.
2. raise the price on the Old Drug by huge margins while simultaneously introducing New Drug at old price.
3. financially strong-arm insurance companies into dropping coverage of Old Drug (the New Drug is cheaper and obviously Better*)
4. when patent on Old Drug actually expires, there are now a ton of people on New Drug. The normal automatic "hey this drug just went generic" programs at the insurance company and doctor's office don't kick in, so people continue to pay metric ass-tons of money, not realizing they could be on their familiar (generally very good) Old Drug for a tenth the cost.
posted by introp at 8:40 AM on January 26, 2011 [1 favorite]

8dot3: "He deserves to be spammed for not having a savvy enough PR team - Asacol is a drug used for colon inflammation. As are Pentasa, Azasan and Colazal. I cannot be the only one who finds this completely hilarious."

Ratio: "Naming an IBD drug 'Asacol' is funny."

<pedantry> The active ingredient in all these drugs is 5-aminosalicylic acid (5-ASA) </pedantry>



But yeah. Even when I was on Asacol, even though I had to take 16 of the giant goddamn pills every day, the name did give me a chuckle every now and then.
posted by joshwa at 3:52 PM on January 26, 2011

Patients and doctors love them because, in theory, non-generics are more likely to work better than generics.

I doubt very many doctors believe that. I certainly don't.
posted by neuron at 9:49 PM on January 26, 2011