"I think we mean what we say: You can do good and do well, and I think we strike that balance around the globe," Ms. Bresch said. Still, she was unapologetic that Mylan's actions were driven by profit. "I am running a business. I am a for-profit business. I am not hiding from that."
How the company, and Ms. Bresch, strikes that balance seems to be quickly changing. Generic drug companies once dealt almost exclusively in making cheap copies of pills and railed passionately against the anticompetitive tactics of brand-name competitors. Now, through a series of acquisitions and mergers, the handful of large generic companies that are left are increasingly investing in expensive brand-name drugs, and in doing so, are embracing many of the tactics they once scorned.
"It's like talking out of both sides of your mouth," said Dinesh Thakur, an advocate for generic drug quality. "To me, I think, it's opportunistic."
In the interview, Ms. Bresch said the company's latest actions would do the most to help patients where it mattered, by reducing their out-of-pocket costs. And she said that the $ 600 list price was necessary for the company to recoup its investment in the EpiPen, which includes raising awareness for severe allergic reaction and making improvements to the way the product works.
But she also sought to shift blame away from Mylan, saying that patients are feeling the pain in part because insurers have increased the amount that customers must pay in recent years.
"What else do you shop for that when you walk up to the counter, you have no idea what it's going to cost you?" she said. "Tell me where that happens anywhere else in the system. It's unconscionable."
To some, the company's response seemed to ring hollow. "It's a real challenge to understand how a management team sits around a board table and makes a decision to raise the price of a lifesaving medication over and over and over, and when the P.R. storm hits, decides to blame someone else for that price increase," said David Maris, an analyst for Wells Fargo. He had warned investors in June that Mylan's price increases on EpiPen and other drugs could soon draw unwanted media scrutiny.
The company is not a stranger to controversy. Robert J. Coury, Mylan's chairman who served as chief executive until 2011, came under scrutiny in 2012 for using the company's corporate jet to travel to his son's music concerts. And last year, The Wall Street Journal reported that one of the board members had undisclosed ties to the land where the company built its new Pittsburgh offices.
Mylan Chief on the $ 600 EpiPen
Heather Bresch, chief executive of Mylan, discusses the controversy surrounding the recent 400-percent increase in her company's life-saving allergy injector.
Photo by CNBC. Watch in Times Video »
Ms. Bresch has also weathered her share of controversy, like when it was discovered that West Virginia University awarded her a business degree 10 years after she had attended the school, even though she had completed only about half of the coursework. A report by the university later concluded that officials wrongly awarded her the degree because she was the daughter of the then-governor Joe Manchin, now a Democratic senator representing West Virginia. Mr. Manchin and Ms. Bresch have said they did nothing wrong.
The company also angered shareholders when it switched its headquarters to the Netherlands, and then used a little-known provision in Dutch law to block a takeover by the pharmaceutical giant Teva, which many investors had favored. The move to the Netherlands in 2014, called an inversion, also reduced the company's tax rate. Mylan is one of a string of pharmaceutical companies that have done inversions in recent years, prompting outcry in Washington and calls to limit the practice.
Ms. Bresch's rising salary has also fueled anger over the EpiPen price increase. Since 2007, when EpiPen was acquired and she was the company's chief operating officer, she earned about $ 2.5 million in total compensation. In 2015, her compensation was nearly $ 19 million. Mylan's board has said in company filings that it believes her pay is justified because she has contributed significantly to the company's growth in recent years.
Ms. Bresch, who has worked at Mylan for 25 years, said her West Virginia upbringing had informed her approach to serving as chief executive. "There is a work ethic and grit about that that allows me to help make a difference," she said.
Some of the chafing at her style, she said, is because people are resistant to change. Her top accomplishments, she said, include getting a federal law passed that required more inspections of overseas drug manufacturers, and improving access to AIDS drugs for patients overseas. "To make change happen, to make a difference, mediocrity doesn't get you there," she said.
Even as they have ruffled feathers within the industry, Ms. Bresch and Mylan have earned measured praise from consumer advocates, who said she wielded her influence in ways that helped consumers.
James Love, director of the consumers group Knowledge Ecology International, said Ms. Bresch opened doors at the Office of the United States Trade Representative when his group and others were working to change provisions in the proposed Trans-Pacific Partnership that they said would have limited access to drugs by people overseas. Mylan, as a seller of generic drugs, shared their interest, he said.
"They came in with some very talented people in the negotiations, and they knew what was going on politically," Mr. Love said.
Still, he said, he opposes their position on the EpiPen and said his group was composing a letter of complaint to the Federal Trade Commission.
"I'm appalled at the price increase," he said. "I don't want to sugarcoat that."
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