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How the pharmacist Robert Herold from Saxony has been drawing attention to the enormous profits in cancer therapies for years – and how the responsible health insurance company was apparently not very interested in this waste of money.
5000 euros, each month, in cash, preferably just put it on the delivery boxes. So, Robert Herold remembers, was the first time he was asked by an oncologist to pay a bribe. At the time he was still very young, having just finished his studies.
At that time, his mother was still running the Central Pharmacy in Falkenstein, Saxony, but because Herold was to take over soon, he had the talks with the oncologist. Those conversations began Herold’s long, 18-year journey that would eventually see him become a cancer drug whistleblower.
In conversations with WDR, NDR“Süddeutsche Zeitung” (SZ) and the ARD magazine Monitorr reports Herold that many a prescription can bring in several hundred, sometimes more than 1,000 euros in profit for a pharmacist who puts together cancer therapies.
The oncologist apparently knew that – and wanted to share in the extreme profit margins, says Herold. That’s why he asked the family’s tax advisor: Is there a legally secure way of paying the doctor 5,000 euros a month? It quickly became clear: they didn’t exist. Herold canceled the oncologist.
Herold: The doctor wanted 20,000 euros a month
A few years later, Herold says, he tried to recruit an oncologist for his pharmacy again. At a meeting, he offered him various services: he could produce flexibly at any time of day or night and deliver to the doctor’s practice, and he would also be happy to take over patient communication.
But none of that should have interested the oncologist, says Herold. Instead, he asked for ten percent of his sales of cancer drugs as a commission: 20,000 euros per month.
It is clear that oncologists must not be put under general suspicion. But even if these are isolated cases and the vast majority of oncologists would not act like this: Herold drew the conclusion for himself at the time: If he does not pay such amounts, “then I have no chance on the market”. There are a total of around 300 pharmacies in Germany that can produce cytostatics.
Health insurance showed up disinterested
Herold finds the enormous profits that cytostatic pharmacists like him can make “morally reprehensible”. And that the public has a right to honesty. He can’t let go of the topic. Three years later he takes the next step. He reports that he meets with those responsible for the largest statutory health insurance company in Saxony, the AOK Plus. He informed her about the enormous profit opportunities in the preparation of cancer therapies. But nothing happened.
But Herold doesn’t give up. Next, he tries to shake up his own association, the Association of Pharmacists Manufacturing Cytostatics (VZA).
In 2016, he says, he tried to sensitize colleagues to think about passing on their purchasing benefits to health insurance companies. “But there was zero interest back then,” was his impression. “Whenever I talk to my colleagues, I get the feeling that they want to keep things the way they are.” In the meantime he has left the VZA.
Association speaks of “compensation”
In the interview, the Association of Pharmacists Manufacturing Cytostatics (VZA) does not doubt “that in individual cases it is possible to generate a particularly low price”. However, such profits are not possible across the entire range. In addition, this also “compensates” for the production, which is “insufficiently remunerated”. The production fee that a pharmacist receives in addition to the drug price is around 100 euros per infusion.
One of the biggest mysteries in the industry has been the low prices at which pharmacists can actually buy cancer drugs. But Herold wants to create transparency and ensure that the health insurance companies learn the real prices, so that finally not so much money of the contributors is wasted.
Checkout received real purchase prices
About five years ago he therefore switched to sending the real purchase prices of the pharmacists to the AOK Plus. WDR, NDR and SZ have received the relevant letters. Since then he has sent around a dozen price lists by e-mail.
And the reaction of the health insurance company? “It’s zero,” says Herold. Nobody seems to care about the waste of money. “I feel like I’m fighting windmills. All he wants is fair reckoning.”
The AOK Plus admits in the conversation that they never passed on the price lists, only information from them. The spokesman for the central association of statutory health insurance companies, Florian Lanz, says in an interview monitorthat he does not know the price lists of the pharmacists. The central association later admits that it received excerpts from such a price list confidentially once in 2020.
Herold is looking for the public
When Herold realizes that his efforts at AOK Plus are having little effect, he decides to go public. He contacts WDR, NDR and SZ and shows its price lists, delivery notes and invoices, which prove the enormous profits cancer pharmacists can still achieve today – at the expense of the general public.
Herold himself has earned a few tens of thousands of euros a year, but nationwide it’s about hundreds of millions of euros that health insurance companies could save every year if they took note of Herold’s lists.
Herold is 44 years old today, but already has the feeling that he will soon be one of the last pharmacists of his kind: smaller local pharmacists who still have their own clean room and use it to prepare chemotherapy for cancer patients.
more problematic trend towards concentration
Because the high profits from cancer drugs have another consequence for pharmacists like Herold: they not only encourage corruption, they also fuel a process of concentration. The business with cancer drugs is particularly worthwhile if you prepare an extremely large number of infusion bags.
Herold can produce the medicines himself in his clean room – but this is being used less and less.
He used to have more than 50 pharmacies with a clean room in Saxony, says Herold, today there are fewer than 20. The Association of Cytostatic Pharmacists does not have official figures either, but he confirms the trend: fewer and fewer on-site pharmacies are still producing cytostatics. The large manufacturers supply cancer doctors with infusion bags, some of whose practices are several hundred kilometers away. Even international financial investors invest in such manufacturing companies – because the preparation of cancer infusions is so lucrative.
Drugs drive through the republic
In 2005, Herold still made 60 percent of its sales from mixing cancer drugs, he says. Today it is still five percent. Some doctors in his region would also prefer to be supplied by manufacturing companies that sometimes drive the cancer drugs hundreds of kilometers across the country. He doesn’t know why these doctors do this and no longer order from a pharmacist in their own region.
In the past few months, they have often discussed in the family about his move to the public. “I’m afraid of appearing as a nag,” says Herold. His wife fears doctors may turn their backs on them. The town in Vogtland where Herold runs his pharmacy is small.
Herold knows that he still has to work in his profession for around 20 years. Despite this – or precisely because of this – he is resisting the changes in his industry. “In the end it’s about the patient and he needs his medicine on site.”