American Medicine God: Starting by Inheriting a Pharmaceutical Company and Selling Medicine

Georgetown Club on the banks of the Potomac River is a two-hundred-year-old red brick building.

There was no sign, and only two security guards in black suits stood silently at the entrance, like two stone lions guarding the gate.

Tonight, a dinner event called the "Healthcare Future Summit" is being held here.

"Did you get through to that number?"

Saul Goodman straightened his dark blue suit, trying to appear less like an unscrupulous lawyer who only exploits legal loopholes. But his bright yellow tie betrayed his ostentatious nature.

"It's working." Victor Corleone toyed with a business card in his hand, left to him by the mysterious man who called himself "Patriot" six months ago.

"He replied, 'Bring your lawyer and your track record. I'll be waiting for you in Washington.'" Victor put the business card in his jacket pocket, looked up at the club in front of him, and said, "So, here we are."

The two handed over their invitations and entered the hall.

Amidst the elegant attire and swaying hair, the most powerful figures in the American medical community are exchanging business cards and pledging their interests.

Victor didn't rush into socializing. He took a martini and went straight to the second-floor terrace, his gaze fixed on the main table in the center of the banquet hall.

There were seven or eight people sitting there. They looked ordinary, neither with the imposing presence of CEOs from large pharmaceutical companies like Pfizer or Merck, nor with the adoration of senators. They resembled a group of retired university professors or accountants, conversing in hushed tones and occasionally letting out polite, restrained laughter.

Strangely, the vice president of Pfizer, the COO of Blue Cross Insurance, and even a deputy commissioner of the FDA were all standing respectfully behind that group of people, holding wine glasses, waiting for their chance to speak.

"So that's the 'big shot' you were talking about?" Saul leaned closer and lowered his voice. "They look like a bunch of community college librarians."

"Don't be fooled by appearances, Thor," Victor replied coldly. "Remember the information I asked you to look up? About PBM."

Saul's expression instantly turned serious: "I remember. Pharmacy Benefit Managers. I looked into that bald old man; he's the senior vice president of UHM (United Health Management). The one with the gold-rimmed glasses is a consultant for ESI (Easy Scripts)."

"They are the gatekeepers," Saul said, looking downstairs. "They hold the power to prescribe medications for tens of millions of insured individuals. They categorize drugs into different tiers (Tiers). Tier 1 is for generic drugs, Tier 2 is for brand-name drugs, and Tier 3 is for out-of-pocket drugs. If a drug can't get into Tier 2, it's just a piece of paper in the hospital, even if the doctor prescribes it."

"That's why he dares to say he's the rule-maker," Victor said, taking a sip of his drink.

Just then, the bald old man at the main table seemed to sense something and looked up at the second floor. His gaze pierced through the noisy crowd and landed on Victor.

He simply raised his glass in a distant gesture, a smile on his face, as if to say: You've finally arrived.

......

Half an hour later. In a private cigar room at the club.

Victor led Saul through the door. Only the bald old man was in the room, sitting on a leather sofa, trimming a Cuban cigar.

"Mr. Corleone, and... Attorney Goodman." The old man didn't stand up, but simply pointed to the sofa opposite him. "I'm 'Patriot.' I'm glad you still have my business card."

"I usually have a good memory for those who can decide my life or death." Victor sat down, relaxing. "You said you'd come back to me when I had my 'army' ready."

"And you did it." Patriot lit a cigar, took a puff, and a hint of admiration flashed in his eyes. "Pink Blitz. Brilliant! More than three thousand beautiful saleswomen, infiltrating every corner of America like a virus. OxyContin's sales curve is higher than my electrocardiogram."

He pulled a report from his briefcase: "In just three months, you've conquered the pain management market on the East Coast and in the South. You've not only sold drugs, you've 'invented' a disease. Implanting the concept of ADHD (Attention Deficit Hyperactivity Disorder) in the minds of pediatricians was a stroke of genius."

"I just followed your advice," Victor said calmly. "You said that in this country, votes are hard currency."

“That’s right. Ballots.” Patriot laughed. “But you seem to have misunderstood me. I’m not just talking about the voters who voted for Reagan. In the medical field, ‘ballots’ refer to prescriptions. Every prescription is a vote a doctor casts for you.”

Patriot leaned forward, his presence increasing intimidation: "Now you've proven you have the ability to garner votes. You have an army, you have territory. You're qualified to sit at the negotiating table."

He pushed a thin document in front of Victor.

"This is a new agreement. UHM manages the health insurance accounts of 3000 million people across the United States. Once you sign up, OxyContin will be included in our Tier 2 list. This means that when these 3000 million people pick up your drug at the pharmacy, they only need to pay a $5 co-pay, and the rest will be covered by the insurance company. Your sales will jump from the current level to the level of a 'national miracle drug'."

Saul picked up the document and quickly scanned the terms. His brow furrowed deeper and deeper.

"40%?" Saul exclaimed. "You're taking 40% of sales as a 'kickback'? That's insane! It's worse than the Mafia extorting protection money!"

"Watch your words, lawyer." Patriot gave Saul a cold look. "This isn't protection money. This is 'market access fees.' Without us, no matter how good your medicine is, it'll only be available in the out-of-pocket market. Do you know how many people in America can afford full-price drugs? Less than 10%."

“Mr. Corleone,” Patriot turned to Victor, “you’re a smart man. It’s unwise to leave the money on the table. Give us 40%, and you still get 60% of the massive market. That’s a win-win situation.”

Victor didn't look at the documents, nor at Saul. He stared at the cigar in Patriot's hand and suddenly smiled.

"You just said that I misunderstood the meaning of 'vote'."

Victor stood up, his humble expression gone.

"No, old man. You've misunderstood."

"Do you think I assembled that pink army just to get doctors to write more prescriptions? Do you think I went to great lengths to curry favor with those village doctors just to earn a little money from medicine?"

Victor stared intently at him.

"If I control the doctors, I control the patients. If I control the patients, I control the real votes."

"Those miners, truck drivers, veterans who rely on OxyContin... they can't live without my medication now. If one day someone tells them that they have to stop taking the medication because a company called UHM doesn't want to reimburse them, guess what they'll do?"

Patriot's expression changed slightly, and the fingers holding the cigar paused for a moment.

Are you threatening me?

"No, I'm teaching you what real 'hard currency' is." Victor walked back to the table and picked up the document.

"hiss!"

Under the horrified gaze of Saul and the cold, menacing watch of Patriot, Victor tore the multi-billion dollar contract in two.

"I won't give you a single cent. OxyContin's value is determined by its efficacy, and even more so by the millions of 'voters' who can't live without it."

"You want to blacklist me? Go ahead." Victor tossed the shredded paper into the trash can, clapped his hands, and said, "But you'd better be prepared. Don't blame me when millions of angry patients surround your insurance company building."

"Let's go, Thor."

Victor turned and walked towards the door.

"Young man," Patriot's voice rang out behind him, no longer composed, but chillingly cold. "You're too arrogant. Do you think this is some street game where you can point a gun at someone's head? This is Washington. Our rules are invisible, but deadly more than bullets!"

"Starting tomorrow, OxyContin will be added to the 'pre-authorization required' list on UHM's network. I'll show you what it means to be unable to move an inch."

Victor stopped and looked back.

"Then let's see whether your rules are tougher or my 'army' is tougher."

boom.

The door is closed!

........

The next morning. Water Pharmaceuticals headquarters.

The fax machine kept ringing.

"They've made their move." Saul stormed into the office, pale-faced, carrying a stack of documents. "UHM, ESI, and two other large PBMs just issued notices simultaneously. OxyContin has been removed from Tier 2. Now, doctors have to fill out five pages of forms and call the PBM for approval for every prescription. Nobody's going to bother with that."

"Sales have already started to plummet."

Victor stood in front of the floor-to-ceiling window, looking down at the bustling streets of Manhattan. His face showed no panic, but rather excitement.

"very good."

"Victor, are you crazy? This is a blacklist!" Thor was frantic.

"No, Saul. This is a mobilization order."

Victor turned around and pressed the intercom button on the table.

"Get me connected to Katie. Tell her to activate 'Plan B'."

Katie's voice came through the phone. "Boss, you were looking for me?!"

"Remember those doctors we secretly contacted through Saul over the past six months? They were the ones we funded for 'academic research' and established 'pain patient support groups' in their localities."

"Saul and your team. Inform them immediately that it's time to turn these scattered sparks into a raging fire. Have them unite their local chapters and form the National Pain Patients' Alliance (NAPPA). Funding is unlimited."

"Let our pink army cooperate with these doctors, stop marketing to those snobbish hospitals, and instead go find patients who can't afford the medicine because it's not covered by insurance."

"Patriots want votes? Then I'll give them my votes."

"We are going to wage a war. Not a commercial war, but a people's war."