Drug company CEO Heather Bresch affectionately describes the humble EpiPen as her “baby,” a once-middling product that she turned into a blockbuster.

With aggressive advertising — and even more aggressive price hikes — Bresch has fostered the EpiPen into a bestseller that brings in more than $1 billion a year in revenue for Mylan Pharmaceuticals.

But the growing furor over drug pricing threatens to turn Mylan’s biggest asset into a liability. And it has forced Bresch into an unwelcome spotlight, as anxiety over the rising cost of medicine has drug industry critics seeking out the next Martin Shkreli.


In the past week, Mylan has faced public scorn, investor skepticism, and castigation from a group of senators calling for an investigation into why EpiPen’s cost has soared fivefold under Bresch’s watch. Even Shkreli, widely perceived as a paragon of greed after hiking a drug price by 5,000 percent, decried Mylan as a group of “vultures.”

The EpiPen, an auto-injector used to reverse life-threatening allergic reactions, is inextricably tied to Bresch, whose ascension at the company tracks with the product’s rapid growth.

At 47, Bresch has spent most of her life at Mylan, working her way up from a secretarial desk in the basement of what was then a small West Virginia firm. In the ensuing years, Bresch has overcome an academic scandal, hostile takeover attempts, and questions about her true control over Mylan.

She has also become one of the drug industry’s highest-paid CEOs, pocketing more than $18 million in cash and stock last year, and sitting at the head of a $26 billion enterprise.

Now, as the specter of a Senate investigation looms, Bresch faces what could become her biggest challenge. And, befitting her uncommon career, it comes with a twist: Among the Senate’s membership is her father, Joe Manchin, a populist West Virginia Democrat whose influence is woven throughout her rise in the drug industry.

Spotting potential in a humdrum product

Bresch first adopted EpiPen in 2007, when Mylan purchased the generic drugs division of Germany’s Merck KGaA for $6.7 billion. It was a milestone for the growing company, and then-CEO Robert Coury appointed Bresch to sort out the integration.

EpiPen was one of about 400 products that Mylan acquired in the deal. And it was unremarkable in business terms: a plastic device that, with the push of a button, injected what Bloomberg has estimated to be about a dollar’s worth of the generic hormone epinephrine to treat deadly anaphylactic shock. It sold for about $57 and made just $200 million a year for Merck KGaA, accounting for less than 5 percent of the company’s generics revenue at the time.

Bresch saw potential in the decades-old auto-injector, and Mylan credits her with spearheading an effort to widen its use. But her drive to make the EpiPen a top seller was almost derailed before it started.

Bresch was promoted to chief operating officer at Mylan shortly after the deal with Merck KGaA. The official corporate announcement touted her MBA from West Virginia University. Months later, an exhaustive investigation by the Pittsburgh Post-Gazette revealed that she hadn’t finished the MBA program — and a later independent report found that university officials had falsified her transcripts to conceal that fact, adding in grades “pulled from thin air.”

The scandal shined a light on Bresch’s status as a member of coal country royalty. Her father, Manchin, was then West Virginia’s governor. And the university’s leadership included longtime family friends and Mylan insiders.

Bresch held onto her job at Mylan, maintaining that she had done everything she needed to do to earn that MBA. Neither she nor her father was accused of wrongdoing. But the episode reeked of cronyism and sparked a faculty protest. WVU’s provost and business school dean later resigned, and the university revoked Bresch’s degree.

Both Bresch and Mylan declined to comment. Manchin’s office didn’t return voicemails left Tuesday.

While the affair was embarrassing for the university, it had little effect on Bresch’s career.

Bresch soon became Mylan’s president and began a crusade to expand the availability of EpiPens. Drawing on her experience as Mylan’s former director of government relations, Bresch led a lobbying campaign to spread the word about the risks of anaphylaxis and the efficacy of EpiPen.

Mylan scored a coup in 2013 with the adoption of the School Access to Emergency Epinephrine Act, which gave preferential federal treatment to schools with EpiPen stockpiles. Sales increased, and Mylan raised the price of its banner product each year.

Talia Bronshtein/STAT Source: Wells Fargo

Questions about corporate control

In 2011, Coury surprised Wall Street by announcing that he’d step down from the CEO role at year’s end, leaving Bresch as his anointed successor. It was to be a major culture shift for Mylan, which had become synonymous with Coury’s blunt, often profane way of conducting business. Bresch, with her lilting West Virginia accent and political savvy, presented a new way forward for a company that had underperformed in the eyes of many analysts.

But Coury never really went away, instead taking on the title of executive chairman. And in the years since Bresch became CEO, it has often been unclear just who is pulling the strings at Mylan.

Last year, when Israeli drug maker Teva Pharmaceutical mounted a hostile takeover attempt, it was Coury who acted as Mylan’s mouthpiece, baiting the other company’s management team and penning a searing 3,000-word letter to its board. At the same time, he starred in Mylan’s failed attempt to acquire rival generics firm Perrigo, sparking a bitter public feud with that company’s CEO before eventually admitting defeat.

In Mylan’s last annual report, the opening note to shareholders is signed by both Coury and Bresch. And letters to the company end up at the Robert J. Coury Global Center, a 280,000-square-foot Pittsburgh outpost christened in 2013.

A ‘patriot’ decamps for foreign shores

But Bresch was front and center for Mylan’s most recent controversy, a politically sticky situation that again looped in her father.

In 2015, Mylan announced that it would move some of its operations overseas in search of a more favorable tax rate. The tactic, known as an inversion, exploits what President Obama has called “one of the most insidious tax loopholes out there.” For Mylan, inversion meant shifting its business address to the Netherlands through a complicated transaction with Abbott Laboratories.

Manchin, who learned of the move only on its official announcement, told The National Journal that what his daughter did ought to be illegal. (He later gave a statement to The New York Times saying Mylan’s move was “systemic of a larger problem with our corporate tax code that puts American companies at a disadvantage with their global competitors.”)

This put Bresch in an awkward spot.

Mylan had long painted itself as a different sort of drug company, one principally concerned with stakeholders — like patients and employees — rather than the short-term profits of shareholders and investment banks. And Bresch had once been hailed by Esquire as a “patriot of the year” for her work to improve safety standards for generic drugs.

So why was her company leaving home in the name of corporate profits?

Bresch’s spin: Mylan needed to ditch the United States to stay in the US. Setting up shop in the Netherlands provided tax savings, sure, but it also gave Mylan the protection of Dutch law, which makes it easier for companies to fend off hostile acquisitions. At the time, Teva was trying to galvanize a shareholder revolt to depose Mylan’s management, something Bresch said could have imperiled patients and employees.

“I said, ‘You know, Dad, we have 5,000 employees in Morgantown, W.Va. — we’re one of the largest employers in West Virginia,’” she told an audience at Fortune’s Most Powerful Women Summit in 2015. “I can guarantee you, if we don’t protect ourselves, no one’s going to protect those jobs.”

Bresch calls EpiPen her “baby.” J. David Ake/AP

Senators take aim at EpiPen price hikes

Explaining EpiPen’s 450 percent price increase may prove more difficult, as the public outrage that once dogged Shkreli’s Turing Pharmaceuticals has shifted to Mylan.

Senator Amy Klobuchar (D-Minn.) has called for the Federal Trade Commission to investigate Mylan’s pricing practices, writing Monday that “not only is this alarming price increase unjustified; it puts lifesaving treatment out of reach to the consumers who need it most.” The same day, Senator Chuck Grassley (R-Iowa) wrote Mylan asking for information on how it set the price for its auto-injector, and Senator Richard Blumenthal (D-Conn.) called for the company to lower the cost of EpiPen.

Days before, Senator Bernie Sanders had tweeted that “there’s no reason an EpiPen, which costs Mylan just a few dollars to make, should cost families more than $600.” A MoveOn.org petition, titled Stop Immoral Price Gouging for Life-Saving EpiPen, had garnered nearly 19,000 signatures as of Tuesday night.

In a statement, Mylan defended its patient-access programs, which it said provide EpiPens for free to 80 percent of insured patients. But the company did not address price increases or their effect on patients without insurance.

Meanwhile, some shareholders are losing faith. The company’s stock price has fallen more than 30 percent since last summer, when Mylan finally shook off the threat of a takeover by Teva. In May, Goldman Sachs downgraded Mylan, citing a “cloud over generic drug pricing.”

And on Tuesday, analysts from Citigroup warned that the current public focus on EpiPen pricing could weigh down Mylan’s stock, especially if the company has to appear before a Senate committee.

If Mylan loses too much value, it could struggle to defend itself from a future hostile takeover. But Bresch herself is well-insured: According to a recent analysis from Bloomberg, if she’s deposed in a merger, she’s in line for a $61.5 million golden parachute.

Leave a Comment

Please enter your name.
Please enter a comment.

  • On the exact day that this story became ‘breaking news’, the commercial with a young girl having a allergic reaction to peanuts at a party was removed from ABC. CBS, and NBC broadcasting’s, it was on all channels repetitiously.

    The EpiPen requires medication that costs One Dollar and the remainder is for to pay for the convenience of having an untrained administer a shot that normally only requires a nurses training + shot can be administered thru clothing, $599.00 for packaging, sealed plastic administer pen, commercials and bonuses.

    Simple Solution would-be inventing a refillable ( by trained pharmacist ) instead of yearly disposable, plastic dispenser, whose cost Should have been in the under $50.00 range!

    Search first clause of the “First Amendment’ = Antitrust = before Taft – Hartly Act redefined the word Antitrust, that facilitated banks shedding governmental regulations. The leading First Amendment Founding Fathers stipulation’ affronting all the freedoms.

    Big pharmacy used Opium to addict using pain pills then removed the pain pills ( forced by government = less income ) followed by news explaining how Heroin ( Opium ) has a street price of 1/10. Creating street friction growth.

    Same reason for Viet Nam war = poppy crop’ whose harvesting ( doubled for 9 years strait = Afghanistan ), with the added rare mineral of lithium ( rechargeable batteries ) mined in Afghanistan, all wars are about commodities.

  • Consider how awful it would be if the Teva takeover were to occur. Teva, who is the leading generic (how do you say low cost) drug manufacturer in the world, and who’s CEO makes 1/6th of Mylan’s CEO, would possibly reduce the selling cost of the epipen, and of course the sole motivation for moving jobs would be eliminated.

    Terrible terrible.

  • 1.) Bresch is not well insured , if taken over she only gets about two years salary.
    2.) Is there some law that says if you move jobs overseas, you cannot be overtaken via a hostile takeover?
    3.) It is quite noble that they give the epipens to those families that insurance would already pay for them, but charge those patients where there is no insurance. Explain to me again why we charge $600 to those that need the help the most, but yet give it for free to those where the insurance pays…. Ohh yea, is that to fund part of the 647% increase over 8 years in the CEO’s almost 30 million dollar salary. NOTE GM’s CEO makes about the same amount as this CEO, for a company that earns about 10 Billion while employing 220,000 employees, compared to the small company mylan earning about 4.2 Billion while only creating about 20,000 jobs, of which are being move overseas I understand. I wonder if she is lowly paid due to the fact she is a woman. I understand there is quite the wage discrimination.

    • 1) If her contract as CEO has stipulations for compensation for removal then she could make that much money, most CEOs do.
      2) No but what the article said is by moving the “company” to Netherlands they have less risk of a hostile takeover from Teva. That doesn’t mean they have to ship jobs overseas for manufacturing.
      3) I used to work at Merck. In my eight years at Merck they did layoffs twice a year, March and November. If the goal of the layoffs was to save money, which is what they tell their investors, then the C*Os could stand to lose a few mill from their pay checks, which could save a lot of jobs. They also did layoffs as a way to get rid of dead weight. The dead weight is typically people who have become too complacent in their jobs that they have subpar performance or never advance. It’s also a good way to defend against discrimination cases if the person let go has a harder time proving it when 10,000 other people were let go too.

      Capitalism in check is good but unchecked, like it has been the past 30 years, has nearly killed off the middle class.

  • I am generally a fan of capitalism. The monetization of resources for the masses is generally good. However, the souless money mongering of big pharma at the expence of children’s lives is, in my estimatiom, unforgivable. As a physician tending to critically and terminally ill children, all I have to say is: “Shame on you.” Shame…that is what you and your company should feel when you lay your heads downs at night. Separate from corporate profit models, saveble children will die because of your profit motives. Let me be clear: children will die to pad your pockets, and those of your nameless shareholders. I hope you all live with that choice uncomfortably.

    Epinephrine (adrenaline) is not a miracle drug of big pharma…it is a natural and life-saving substance that the human body makes. Having a lock on the supply chain and proprietary delivery mechanism does not make Milan an innovative discovery company (which I could respect), but a brutish profiteer using an essential basic medicine as a profit lever.

    As a 1%er, as a parent, and as a medical caregiver to seriously ill children, MYLAN and BRESCH are now on my personal black list.

    • You are so right. I just wished President Obama held his ground and brought in generics from Canada to compete like he said he would, this probably wouldn’t happen. The Pharmaceutical companies donated $2 billion to the healthcare reform bill to avoid it and Obama foolishly agreed, not realizing they would simply raise their prices to get the money back from consumers. Although Obama’s intentions were good, he naively thought he can stop or control greedy millionaires from always wanting more at the expense of the poor or middle class. Anyone interested in bringing that back to life while this topic is hot?

    • Pharma companies donated about $85.00 billion and not $2.00 billion. Anyone would fall for it. Patients got shorted.

  • The way things have been going lately, she could end up the next surgeon general…. I mean why not… I’m sure she could find a pretend medical degree to go w/her pretend MBA…

  • A friend said “karma” would level the field…. I laughed, just look at this “woman” and the rest of the 1%ers…. They are hyenas that ALWAYS end up on top….

Sign up for our Daily Recap newsletter

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy