Oh boy, do I have a treat for you guys today. The kind that makes you breathe deeper, gets you feeling all hot and bothered inside, the kind of treat that really gets the blood boiling. Hope I didn’t give it away yet. You ready?

It’s corporate greed and gross indifference towards human suffering, of course! How quaint. Naturally, Mylan is the centerpiece of the show. So let’s dive right into it.

But first:

Meet Robert Coury. He’s a firm believer in self-love. You’ll see.
Image via YouTube.

A short recap

A while ago we fired a few shots at Mylan and its CEO Heather Bresch for the ludicrous price increases of the company’s signature EpiPen. She found herself in the ignominious position of testifying in front of Congress with the same credibility of a schoolgirl blaming the dog for eating her homework, then not being able to recall what the homework was.

The short of it is that Bresch wasn’t able to remotely justify the product’s 500% price increase since 2007 when Mylan acquired its patent rights. It also became apparent that the company strong-armed schools into effectively banning lower-cost alternatives from their nurse offices via the EpiPen4Schools program, all adding up to something which Rep. Tammy Duckworth rightfully called a “monopoly”.

To add a little Godfather (Godmother?) twist into the whole thing, schools were “strongly encouraged” or downright required to have anti-anaphylactic meds on hand following an unprecedented push by the National Association of State Boards of Education (NASBE) — which was headed since 2012 by Gayle Manchin, Bresch’s mother. Naturally, the schools weren’t informed of the blood ties between NASBE and Mylan when they were signing the deals.

“Eleven states drafted laws requiring epinephrine auto-injectors. Nearly every other state recommended schools stock them after what the White House called the “EpiPen Law” in 2013 gave funding preference to those that did,” USA Today reported on the issue.

Altogether, Congress had a lot of ‘slippery’ during the hearing and almost no hard answers — if you’ve missed it, here it is again, so you can give it a read. Because you’re going to need all the warm-up you can get for this next bit.

Anatomically incorrect

As you can probably tell, the whole thing basically pissed everyone off, except the shareholders. Mylan has had to deal with a very harsh backlash from customers, advocates, federal investigators, lawmakers, all the works, but the price of EpiPen is still not dropping. Which is puzzling, to say the least — what Mylan is doing is the economic equivalent of putting on the noose and handing the rope to the same people whose kids, friends, and relatives are dying to a peanut because they can’t shell out $609 on a pack of life-saving medicine. The parents, family, and friends of some 15 million of Americans.

It’s all terribly puzzling until you factor in that Mylan has, for all intents and purposes, a near monopoly on a vital product and/or hear about their creative take on marketing strategy. It’s all courtesy of The New York Times’ Charles Duhigg, who sat down with 10 of the company’s former mid-level executives and also talked with CEO Heather Bresch to pick their brains on the matter.

According to these former executives (all of whom asked to remain anonymous citing nondisclosure agreements and potential retaliation from Mylan), the company’s top brass fully expected a public outrage over its price hiking and planned to simply ignore it. These former execs say they’ve repeatedly raised concerns that the hiking amounts to “unethical profiteering” on the backs of patients with no other alternative, all the way back since 2014. And here’s where it gets really good:

“Over the next 16 months, those internal warnings were repeatedly aired. At one gathering, executives shared their concerns with Mylan’s chairman, Robert Coury,” Duhigg writes. “Mr. Coury replied that he was untroubled.”

“He raised both his middle fingers and explained, using colorful language, that anyone criticizing Mylan, including its employees, ought to go copulate with themselves. Critics in Congress and on Wall Street, he said, should do the same. And regulators at the Food and Drug Administration? They, too, deserved a round of anatomically challenging self-fulfillment.”

“When the executives conveyed their anxieties to other leaders, including the chief executive, Heather Bresch, these, too, were brushed off, they told me.”

I can only tip my hat to Mr. Duhigg’s impressive word taming skills. The point makes its way across nicely. Though I warmly invite Mr. Coury to show us all how it’s done.

Unethical is putting it mildly

I’d suggest he start with one of these. Considering the price they’re going for it’s guaranteed to increase his self-worth.

You may be surprised to find that despite receiving around $160 million in compensation last year from Mylan, Mr. Coury declined to comment on the matter — who would have thought, right? Bresch luckily didn’t, and it’s from her we learn that Mylan is, in fact, “a pretty rare and unconventional company,” wholly dedicated to the consumer, delivering low-cost meds, snooze, snooze, snooze. It’s the broken healthcare system that’s bringing the company down, bringing prices up, and causing all this hardship for the people in need.

To back her words, she mentions the generic version of EpiPen, which Mylan released after their meltdown of a Congress hearing. A two-pack of these will take you back less than the brand-name two pack, but as always, there’s a caveat.

“When I asked my pharmacist for the generic EpiPen,” Duhigg recounts, “he told me that I would have to wait 90 minutes, until he could get my doctor on the phone to authorize the substitution. Then, he charged me $370 for the generics.”

A far cry from the $100-a-two-pack price the pens were sold for before Mylan got in on the business — and an inexcusable leap from the $35 EpiPencil Four Thieves Vinegar proved you can make at home. Even if that price was excusable, how many of us would be willing to wait for an hour and a half to get the cheaper pen when your kid can’t breathe back home? How enjoyable will that wait be when the generic kind is all you can afford, even if it means no food today, tomorrow, the whole week — maybe the week after that? Unethical profiteering seems too small a term when seen from this light, doesn’t it?

In the end, Mylan made some $1.1 billion in revenue every year from the EpiPen alone. And its CEOs are the highest paid in the industry. Shame and loathe be onto them. But I think it’s clear that left to their own devices, Mylan’s top brass won’t change. They don’t see any reason to. Change has to come from outside — affordable alternatives to the EpiPen (pills and auto-injectors) are slowly becoming available, and doctors need to start prescribing those (as well as other competing products) in place of what Mylan has to offer. Pharmacists, too, should guide customers to non-Mylan alternatives.

Because if they have an alternative to the EpiPen, all those hands holding the noose will have not only a motive but also a means to pull on the rope.