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The new drug looked so promising except for that one warning sign.

This story also ran on Fortune. It can be republished for free.

At the American College of Rheumatologys annual meeting in 2008, Duke Universitys Dr. John Sundy proudly announced that pegloticase, a drug hed helped develop, was astoundingly effective at treating severe gout, which affects perhaps 50,000 Americans. In about half of those who had taken it, the drug melted away the crystalline uric acid deposits that encrusted their joints to cause years of pain, immobility, or disfigurement.

But Sundy also disclosed an unsettling detail: In one clinical trial, patients who got the drug were more likely to develop heart problems than those who didnt. The day after Sundys talk, the stock price of Savient Pharmaceuticals, which developed the drug with Duke scientists, plunged 75%.

That danger signal would disappear in later studies, and the FDA approved pegloticase, under the trade name Krystexxa, two years later. But the small biotech company never recovered. In 2013, Savient was sold at auction to Crealta, a private equity venture created for the purpose, for $120 million.

Two years later, a young company now called Horizon Therapeutics bought Crealta and its drug portfolio for $510 million.

Even at that price, it proved a good deal. Krystexxa brought in $716 million in 2022 and was expected to earn $1 billion annually in coming years.

Although Horizon says it now has 20 drugs under development, in its 15 years of existence it has yet to license a product it invented. Yet the company has managed to assemble a war chest of lucrative drugs, in the process writing a playbook for how to build a modern pharmaceutical colossus.

As the White House and both parties in Congress grapple with reining in prescription drug prices, Horizons approach reveals just how difficult this may be.

Horizons strategy has paid off handsomely. Krystexxa was just one of the many shiny objects that attracted Amgen, a pharmaceutical giant. Amgen announced in December that it intends to buy Horizon for $27.8 billion, in the biggest pharmaceutical industry deal announced in 2022.

Horizons CEO, Tim Walbert, who will reportedly get around $135 million when the deal closes, has mastered a particular kind of industry expertise: taking drugs invented and tested by other people, wrapping them expertly in hard-nosed marketing and warm-hued patient relations, raising their prices, and enjoying astounding revenues.

Hes done this with unusual finesse courting patients with concierge-like attention and engaging specialist clinicians with lunches, conferences, and research projects, all while touting his own experience as a patient with a rare inflammatory disease. Walberts company has been particularly adept at ensuring that insurers, rather than patients, bear the costly burdens of his drugs.

A federal prosecutor in 2015 began examining allegations that Horizons patient assistance program had worked with specialty pharmacies to evade insurers efforts to shun Horizons expensive drugs. A separate probe opened in 2019 over alleged kickbacks to pharmacy benefit managers, companies that negotiate to get Horizons drugs covered by insurers. Those investigations appear to be no longer active, Horizon spokesperson Catherine Riedel said. The company this year disclosed a third probe, concerning methods the company allegedly used to get prior authorization of its drugs. Justice officials did not respond to requests for comment on the investigations. Email Sign-Up

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An Injection of Marketing

To help sell its drugs, Horizon blankets specialist physicians with marketing and peer-to-peer appeals. Its payments to physicians for things like consulting, speeches, and meals totaled $8.7 million in 2021, compared with the $10 million it paid them for research, federal records show. By contrast, Seagen, a biotech company of roughly the same size, paid doctors a total of $116 million, with nearly $112 million of that pegged for research. Riedel said Horizons marketing and educational approaches were necessarily unique because of the challenges of treating rare and neglected diseases.

Walbert launched Horizon in 2008 in the Chicago area by combining and refashioning generic drugs into single pills. Duexis, Horizons first drug, is a mixture of generic Motrin and Pepcid. Its Vimovo combines generic Aleve and Nexium. In a 2017 article, a ProPublica reporter described being prescribed Vimovo for a shoulder injury. It cost him nothing, but his insurer was billed $3,252 for pills that together cost about $40 for a months supply in generic form. Horizon sold more than $57 million worth of Vimovo that year.

In 2014 and 2015, respectively, Horizon picked up two relatively new drugs that had no generic versions: the immunosuppressant Actimmune and Ravicti, which treats a rare genetic disorder. Soon Horizon was charging more than $50,000 a month for each, placing Actimmmune fourth and Ravicti second on GoodRxs 2020 list of the most expensive U.S. drugs.

Horizons net sales soared from $20 million in 2012 to $981 million in 2016; Walberts pay package followed suit, topping an astronomical $93.4 million in 2015 in salary and stock. Stock analysts questioned the long-term soundness of a strategy of simply selling old drugs for mind-boggling prices, but Walbert was using the cash to refashion the company as a rare-diseases franchise.

His approach would make Walbert a darling of pharmaceutical investors and his board, which lavished him with over $20 million in compensation each of the past three years. While most biotechs and startups borrow heavily from venture capital to do science and have no idea how to develop and market a drug, Walbert got cash coming in quickly. He did it backwards, said Annabel Samimy, an analyst at Stifel Financial Corp. Horizon built commercial platforms before they got into drug development.

Generating robust sales of what sounded like not very interesting drugs allowed Walbert to start a company on not very much, said Oppenheimer analyst Leland Gershell. All the while, Horizon funded and cultivated the patient advocacy groups that can help lobby for a drug to be approved by the FDA and placed on insurers formularies, the lists of drugs health plans cover for patients.

Capitalizing on His Own Illness?

As Walbert and his spokespeople often point out, Walbert and his youngest son suffer from a rare disease, and Walbert also has an autoimmune disease. Walbert wont name the diseases, but has said hes taken the anti-inflammatory injectable Humira since 2003 the year he led that drugs commercial launch as a vice president at Abbott Laboratories. Humira has become the bestselling drug in history, with about $200 billion in all-time global sales.

In 2014, Walbert moved Horizons headquarters to Ireland, which nearly halved its tax rate. A year later it gained control of Krystexxa, and in 2017 it bought, for $145 million, a failing company that produced Tepezza, a drug for thyroid eye disease, which causes unsightly eye bulging and pain.

Tepezza quickly became a blockbuster, with $3.6 billion in total sales in 2021 and 2022. The company conducted additional clinical research on both Tepezza and Krystexxa, but it also spent heavily promoting these and other drugs to specialists who could prescribe them.

All the while it steadily raised prices. Savient put Krystexxa on the market in 2011 at $2,300 per injection. Horizon charges roughly 10 times as much. Six months of Tepezza treatment can run more than $400,000.

Horizons publicity emphasized the companys sensitivity to patients, and its constant contact with disease advocates.

Our scientists are attuned to the unmet needs of patients, their diagnostic and therapeutic journey, Bill Rees, Horizons vice president for translational sciences, told KFF Health News. Its the marrying of the basic clinical science with a focus on the needs of the patient that differetiates us.

To make sure patients keep using its drugs, clinicians say, Horizon staffers negotiate with insurance carriers, and the company offers drug discounts to lower-income patients while swaddling them with attention from its medical staff.

Horizon has a nurse talk to each and every patient before every appointment, said Dr. Brigid Freyne, who treats around half a dozen patients each year with Krystexxa at her Murrieta, California, rheumatology clinic. The patients who come in here are highly motivated to get their IV. They get the message that its very important and they are fortunate to get the medicine.

None of the manufacturers of her other infusion drugs shower patients with this kind of attention, she said.

While at Abbott, Walbert pioneered direct-to-consumer advertising for specialty drugs like Humira, a trend that aggravated insurers, who anticipated, correctly, that they would soon be shelling out billions for expensive drugs.

Horizons marketing plan for Krystexxa includes direct-to-consumer ads aimed at driving patients to specialists. The drug is designed for recalcitrant gout patients, who often have large lumps on their fingers, feet, and kidneys. Many, though not all, are heavy drinkers of beer or soda sweetened with high-fructose corn syrup, which can increase the buildup of uric acid, the cause of gout, said Dr. Robert McLean of Yale University.

While Krystexxa can help patients with advanced gout, the American College of Rheumatology views it as a drug of last resort, with plenty of cheaper, early intervention alternatives available.

I prescribe it maybe once a year, McLean said. From a cost-effectiveness standpoint, it warrants questioning.

Horizon recently started a publicity campaign addressed to all gout sufferers, urging them to see a rheumatologist or a nephrologist the specialists it has targeted with Krystexxa educational materials before the disease does too much harm.

Horizon would like you to say, Everyone with serious gout should be started on Krystexxa, said Dr. James ODell, a rheumatologist at the University of Nebraska Medical Center. The Horizon pitchmen he deals with are nice guys, but we dont believe thats the best way.

The company defends its marketing practices. We learn what matters most to patient communities and act. This approach has been validated by independent third-party research, said Riedel.

The Federal Trade Commission said in January it was seeking more information on the Amgen-Horizon merger. Sen. Elizabeth Warren (D-Mass.), citing high prices for Horizon and Amgen drugs, urged the agency to nix the deal.

Arthur Allen: ArthurA@kff.org, @ArthurAllen202 Related Topics Health Care Costs Health Industry Pharmaceuticals Drug Costs Prescription Drugs Contact Us Submit a Story Tip

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MP tells Sky News she was attacked online by Tate brothers after Commons contribution

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MP tells Sky News she was attacked online by Tate brothers after Commons contribution

An MP has told Sky News she was attacked online by the Tate brothers after she participated in a debate in the House of Commons about violence against women.

The controversial duo, Andrew and Tristan Tate, are facing charges of rape and human trafficking in the UK – all of which they deny.

But they are still very active online, and according to Sorcha Eastwood, the MP for Lagan Valley, are targeting her.

In a document seen by Sky News, Tristan Tate has highlighted one of the MP’s tweets and writes in private correspondence: “MP, nice target, can we sue her?”

Sorcha Eastwood says at first she thought the replies were from parody accounts and not the Tate brothers.

Her original tweet was about Elon Musk, not the Tate brothers. The MP said Musk’s tweets should be looked at through a counter-extremism lens.

“I was really concerned, I was concerned because to me that is a direct attack for want of a better phrase on me serving my constituents.

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“I couldn’t believe that they decided to pick this random Northern Irish MP. The fact that it wasn’t even about them. This is something I didn’t go looking for.

“I think from my perspective, it’s a very, very sinister attempt to shut down important voices in public life, political discourse.”

It was only when she started noticing an uptick in abuse from other accounts she realised she had encountered some of the brothers’ followers.

“I had rape threats. I had death threats. I had people saying I should be hung from a lamppost. I had people saying I should be chopped into liver. I also had people then who were like we’ll waste 15 minutes raping Sorcha Eastwood.”

Andrew and Tristan Tate
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A representative for the Tate brothers told Sky News that there was no targeted campaign against Sorcha Eastwood

A representative for the Tate brothers told Sky News that there was no targeted campaign against her.

They said: “Ms Eastwood has a distorted view regarding social media if she believes one is required to ‘invite or ask’ people to interact.

“Tristan Tate is entitled to his view in relation to her tweet regarding Elon Musk.”

The self-styled “misogynist influencer” Andrew Tate and his brother Tristan have both been charged with human trafficking, face allegations of trafficking minors, sexual intercourse with a minor and money laundering in Romania.

There is also a European arrest warrant for them as they are facing separate, unrelated charges of rape and human trafficking in the UK. They deny all charges.

Ms Eastwood now worries for others who don’t have a platform like her and who may not feel like they can speak out.

“If this is what has happened to me I have absolutely no doubt that this has happened to others where they have been attempted to be silenced.”

Keir Starmer has previously commented on the Tate brothers’ case in the Commons saying it is “a live issue”, but adding that “the principle is absolutely clear” in relation to whether the brothers should face justice.

Sorcha Eastwood says she wants to see the government do much more to protect against abuse online.

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Tate brothers deny wrongdoing

“I think ultimately the government has taken the wrong course on this. They need to step up.

“This should be an issue of national security as far as the radicalisation of young people online. It should be an issue in terms of the levels of misinformation, disinformation and the lack of trust that is had in our politics right across the UK and Europe.

“I want the government to help me, help every other person to crack down on this and get serious about it. And the only way they’ll be able to do that, is by hitting these tech companies in the only language which they understand, which is money and via robust legislation.”

A government spokesperson said: “Violence against women and girls is a scourge on our society which is why we have set out an unprecedented mission to halve these crimes within a decade.

“Tackling illegal abuse both online and offline is central to supporting victims and preventing harm in our communities and we will not hesitate to strengthen laws to deliver this mission.

“Last month, parts of the Online Safety Act came into force meaning companies must take action to protect users from illegal material including extreme sexual violence.

“Further protections from this summer will require platforms to protect children from harmful, misogynistic, and violent content.”

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De minimis trade loophole that boosted Chinese online retailers to end May 2

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De minimis trade loophole that boosted Chinese online retailers to end May 2

A driver for an independent contractor to FedEx delivers packages on Cyber Monday in New York, US, on Monday, Nov. 27, 2023.

Stephanie Keith | Bloomberg | Getty Images

President Donald Trump on Wednesday signed an executive order shutting the de minimis trade loophole, effective May 2.

Trump in February abruptly ended the de minimis trade exemption, which allows shipments worth less than $800 to enter the U.S. duty-free. The order overwhelmed U.S. Customs and Border Protection employees and caused the U.S. Postal Service to temporarily halt packages from China and Hong Kong. Within days of its announcement, Trump reversed course and delayed the cancellation of the provision.

Wednesday’s announcement, which came alongside a set of sweeping new tariffs, gives customs officials, retailers and logistics companies more time to prepare. Goods that qualify under the de minimis exemption will be subject to a duty of either 30% of their value, or $25 per item. That rate will increase to $50 per item on June 1, the White House said.

Use of the de minimis provision has exploded in recent years as shoppers flock to Chinese e-commerce companies Temu and Shein, which offer ultra-low cost apparel, electronics and other items. The U.S. Customs and Border Protection has said it processed more than 1.3 billion de minimis shipments in 2024, up from over 1 billion shipments in 2023.

Critics of the provision say it provides an unfair advantage to Chinese e-commerce companies and creates an influx of packages that are “subject to minimal documentation and inspection,” raising concerns around counterfeit and unsafe goods.

The Trump administration has sought to close the loophole over concerns that it facilitates shipments of fentanyl and other illicit substances on the claims that the packages are less likely to be inspected by customs agents.

Temu and Shein have taken steps to grow their operations in the U.S. as the de minimis loophole has come under greater scrutiny. After onboarding sellers with inventory in U.S. warehouses, Temu recently began steering shoppers to those items on its website, allowing it to speed up deliveries. Shein opened distribution centers in states including Illinois and California in 2022, and a supply chain hub in Seattle last year.

WATCH: President Trump signs executive orders for reciprocal tariffs

Pres. Trump signs executive orders for reciprocal tariffs

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Donald Trump announces sweeping global trade tariffs – including 10% on UK imports

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Donald Trump announces sweeping global trade tariffs - including 10% on UK imports

Donald Trump has announced a 10% trade tariff on all imports from the UK – as he unleashed sweeping tariffs across the globe.

Speaking at a White House event entitled “Make America Wealthy Again”, the president held up a chart detailing the worst offenders – which also showed the new tariffs the US would be imposing.

“This is Liberation Day,” he told a cheering audience of supporters, while hitting out at foreign “cheaters”.

Follow live: Trump tariffs latest

He claimed “trillions” of dollars from the “reciprocal” levies he was imposing on others’ trade barriers would provide relief for the US taxpayer and restore US jobs and factories.

Mr Trump said the US has been “looted, pillaged, raped, plundered” by other nations.

President Donald Trump holds a signed executive order during an event to announce new tariffs in the Rose Garden of the White House, Wednesday, April 2, 2025, in Washington. (AP Photo/Evan Vucci)
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Pic: AP

His first tariff announcement was a 25% duty on all car imports from midnight – 5am on Thursday, UK time.

Mr Trump confirmed the European Union would face a 20% reciprocal tariff on all other imports. China’s rate was set at 34%.

The UK’s rate of 10% was perhaps a shot across the bows over the country’s 20% VAT rate, though the president’s board suggested a 10% tariff imbalance between the two nations.

It was also confirmed that further US tariffs were planned on some individual sectors including semiconductors, pharmaceuticals and critical mineral imports.

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Trump’s tariffs explained

The ramping up of duties promises to be painful for the global economy. Tariffs on steel and aluminium are already in effect.

The UK government signalled there would be no immediate retaliation.

Business and Trade Secretary Jonathan Reynolds said: “We will always act in the best interests of UK businesses and consumers. That’s why, throughout the last few weeks, the government has been fully focused on negotiating an economic deal with the United States that strengthens our existing fair and balanced trading relationship.

“The US is our closest ally, so our approach is to remain calm and committed to doing this deal, which we hope will mitigate the impact of what has been announced today.

“We have a range of tools at our disposal and we will not hesitate to act. We will continue to engage with UK businesses including on their assessment of the impact of any further steps we take.

“Nobody wants a trade war and our intention remains to secure a deal. But nothing is off the table and the government will do everything necessary to defend the UK’s national interest.”

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Who showed up for Trump’s tariff address?

The EU has pledged to retaliate, which is a problem for Northern Ireland.

Should that scenario play out, the region faces the prospect of rising prices because all its imports are tied to EU rules under post-Brexit trading arrangements.

It means US goods shipped to Northern Ireland would be subject to the EU’s reprisals.

The impact of a trade war would be expected to be widely negative, with tit-for-tat tariffs risking job losses, a ramping up of prices and cooling of global trade.

Research for the Institute for Public Policy Research has suggested more than 25,000 direct jobs in the UK car manufacturing industry alone could be at risk from the tariffs on car exports to the US.

The Society of Motor Manufacturers and Traders (SMMT) had said the tariff costs could not be absorbed by manufacturers and may lead to a review of output.

The tariffs now on UK exports pose a big risk to growth and the so-called headroom Chancellor Rachel Reeves was forced to restore to the public finances at the spring statement, risking further spending cuts or tax rises ahead to meet her fiscal rules.

Read more:
What do Trump’s tariffs mean for the UK?
The rewards and risks for US as trade war intensifies

A member of the Office for Budget Responsibility (OBR), David Miles, told MPs on Tuesday that US tariffs at 20% or 25% maintained on the UK for five years would “knock out all the headroom the government currently has”.

But he added that a “very limited tariff war” that the UK stays out of could be “mildly positive”.

He said: “There’s a bit of trade that will get diverted to the UK, and some of the exports from China, for example, that would have gone to the US, they’ll be looking for a home for them in the rest of the world.

“And stuff would be available in the UK a bit cheaper than otherwise would have been. So there is one, not central scenario at all, which is very, very mildly potentially positive to the UK. All the other ones which involve the UK facing tariffs are negative, and they’re negative to very different extents.”

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