How pharma bro Martin Shkreli described his own drug price hike: ‘Almost all of it is profit’

In late May of last year, Turing Pharmaceuticals, then a little-known drug company, was nearing a deal to acquire Daraprim, a 62-year-old drug that fights a rare but severe parasitic infection.

"Very good. Nice work as usual," the company's young chief executive, Martin Shkreli, wrote to the chairman of the board. "$1 bn here we come."

In August, he wrote that hiking the price of the drug would bring in $375 million a year -- "almost all of it profit," which he predicted would continue for three years.

"Should be a very handsome investment for all of us," Shkreli wrote. "Let's all cross our fingers that the estimates are accurate."

By the end of that year, Shkreli would be a minor celebrity -- a "pharma bro" notorious for his unapologetic drug price increase, which cast an intense spotlight on how the pharmaceutical industry operates. Turing, the company that promptly jacked up the price of a single pill of Daraprim by more than $700 would be under Congressional investigation.

In the run-up to a Thursday hearing, Rep. Elijah E. Cummings (D-Md.), ranking member of the House Committee on Oversight and Government Reform, released two memos summarizing some of its key findings so far. The committee received more than 250,000 pages of documents turned over by Turing and more than 74,000 pages from Valeant Pharmaceuticals, a second company that appears to have built its business model around significant price increases of drugs that it did not invent.

[How an $84000 drug got its price: "Let's hold our position "]

The internal documents provided by Turing provide a window into the operations of the company, showing that the skyrocketing drug price was part of the plan from the beginning. The company anticipated that the drug's main audience -- the organized community of HIV patients whose weakened immune systems make them vulnerable to the infection -- could pose a problem because of their expert use of advocacy. But they thought this could be kept under control since in general in the U.S., no one pays the full list price of the drug. Although the company has emphasized that its patient assistance programs and discounts meant that no patients paid full price for the drug, the internal documents reveal that some patients did experience high co-pays, with at least one patient facing a $16,830 coinsurance payment and another with a $6,000 co-pay.

"We may need to make some updates based on co-pay amounts we've been seeing since the price change ... there are patients waiting now for product who have a $6,000 co-pay," Tina Ghorban, the director of business analytics and consumer insights at Turing wrote in an internal email in August.

But even as these wrinkles developed, the company continued to make significant revenue from the drug.

In mid-September, Ghorban wrote in an internal email that a single purchase had come through for 96 bottles of Daraprim. Previously, a bottle of the medicine cost $1,700 -- but the company had recently raised the price to $75,000. That single order nearly equaled the annual sales of the company Turing had bought the drug from, according too Ghorban.

"Another $7.2 million," Ghorban wrote. "Pow!"

Hospitals also began to contact the company to let it know that the price increase had made it difficult to obtain drugs. Massachusetts General Hospital in Boston complained to the company in early October that after spending a week trying to obtain Daraprim for an uninsured patient, they had not had succcess and had received inaccurate information from the team.

"I think we are acting a little like a deer in the headlights, and need to take some action steps now," Ed Painter, the head of investor relations wrote in an e-mail. "If a hospital like Mass General is having issues, we are in trouble."

Shkreli constantly stressed that the company was giving away the drug, for example saying that the price to Medicaid was very low: "90%+ off the list price," he wrote on Twitter.

In internal communications, that compassionate tone shifted. When Shkreli was told that Medcaid represented 23 percent of the drug it was selling to Walgreens, he responded: "Nice, so only 23 percent of drug is being given away?"

As media attention continued to focus on the company, its leaders debated strategy: a commitment to reducing the price by X percent per year, in part to discourage generic competitors from coming online.

"I don't think so," Patrick Crutcher, director of business development at Turing, responded. "Think it's best we don't PR [press release] a something like that unless it's something we're willing to commit to doing."

[The drug industry wants us to think Martin Shkreli is a rogue CEO. He isn’t.]

An outside consultant brought in during October suggested that Shkreli step down as chief executive and a significant price decrease occur.

"This will force reporters to focus on the byzantine nature of drug pricing and health care and ensure the patient message gets out," the consultant wrote.

Instead, Shkreli stayed and the price did not budge.

It was not until Shkreli was charged with securities fraud charges for his actions at previous companies, unrelated to the drug prices hikes, that Shkreli stepped down as chief executive.

“These new documents provide a rare, inside look at the motivations and tactics of drug company executives,” Cummings said in a statement.  “They confirm what Americans across the country have experienced firsthand for years—that many drug companies are lining their pockets at the expense of some of the most vulnerable families in our nation.  The documents show that these tactics are not limited to a few ‘bad apples,’ but are prominent throughout the industry.”

The hearing will be a strange line-up. The chief executive of Valeant Pharmaceuticals, one of the companies that has drawn scrutiny for raising drug prices, has been out on medical leave since December, after being hospitalized with severe pneumonia. So Howard Schiller, the interim chief executive, will attend in his stead.

The star of the hearing is inarguably Martin Shkreli, the former chief executive of Turing Pharmaceuticals who stepped down from leading the company after he was charged with securities fraud in December. The company's current chief commercial officer, Nancy Retzlaff, will be there, but Shkreli, who has become a celebrity of sorts for his carefully cultivated social media personality is the one people will be interested in -- although his presence may be disappointing, since he has vowed to take the Fifth Amendment.

Shkreli has a garrulous social media stream and never seemed to shy away from saying what he thinks before, but if there's one thing the last few months have revealed about him, it's that he loves surprising people.

"They can ask me any question,"  Shkreli told Bloomberg News.  "‘What color is the sky?’ 'Fifth Amendment.'"

Carolyn Johnson is a reporter covering the business of health. She previously wrote about science at The Boston Globe.