Purdue Paid Off Middleman to Block West Virginia Plan to Limit Prescriptions

Purdue Paid Off Middleman to Block West Virginia Plan to Limit Prescriptions

Back in 2001, OxyContin was seen as the prime force driving the fledgling prescription opioid epidemic across America. In West Virginia, addictions and overdose deaths had reached unprecedented levels. And oxycodone - the active ingredient in Purdue Pharma's extended-release painkiller OxyContin - was identified as the main culprit. To meet the invader head on, state health officials decided that a prior authorization from insurance companies for every OxyContin prescription would help. Only patients who really needed the painkiller - such as terminal cancer patients - would get the drug. This would cut down on abusers and also reduce the number of pills reaching the streets.

The state's plans were never realized, thanks to some behind the scenes jockeying, says the pharmaceuticals newsletter STAT which investigated the situation and broke the story in October. Purdue thwarted the state's plans, says STAT, "by paying a middleman, known as a pharmacy benefits manager, to prevent insurers from limiting prescriptions of the drug." "The agreement between Purdue and the pharmacy benefits manager, Merck Medco, came to light in West Virginia court records unsealed by a state judge at the request of STAT, and in interviews with people familiar with the arrangement," the newsletter says. Merck Medco was a subsidiary operation owned by drugmaker Merck & Co. The records from 2001 reveal that drugmaker Purdue paid Merck Medco to ignore the state's requests for pre-authorization and instead instruct insurance carriers to continue to provide OxyContin as before. The inducements paid to Merck Medco were in the form of rebates for keeping OxyContin on insurance tiers requiring no preauthorization and with low copayments. "We were screaming at the wall," said Tom Susman, who headed the state's public employee insurance agency in the early 2000s and led the push to limit OxyContin prescribing in West Virginia. "We saw [the opioid epidemic] coming.

Now to see the aftermath is the most frustrating thing I have ever seen," Susman told STAT. In the ensuing years, reports STAT,West Virginia has suffered the highest per capita drug overdose death rate in the country - more than double the national average - and has one of the highest opioid painkiller prescription rates. "In McDowell County, where the court records from a state lawsuit against Purdue were unsealed," STAT reports, "the local sheriff said prescription pill abuse is so rampant that the county plans to file a new lawsuit against painkiller makers." If it does so, the county will be joining several other states, counties and even a city (Chicago) in filing suits against opioid drug makers. The Merck Medco rebate strategy "extended to other big pharmacy benefit managers and to many other states," according to Bernadette Katsur, a former Purdue official whose job was ensuring "favorable treatment" for OxyContin. "That was a national contract," Katsur told STAT. "We would negotiate a certain rebate percentage for keeping it on a certain tier related to copay or whether it has prior authorization. We like to keep prior authorization off of any drug." Drug companies "commonly pay rebates to gain preferential treatment from companies hired by insurance plans to manage prescription drug benefits," the STAT article reports.

But in this case, the article says, the scheme removed a key safeguard in the system" that could have slowed the growth of OxyContin and of the overdose death rates in West Virginia. A study just published by the Centers for Disease Control and Prevention (CDC) describes how, in Massachusetts, a private insurer's pre-authorization plan has reduced opioid prescribing by 15 percent. Meanwhile, the problem of drug companies aggressively - and sometimes illegally - scamming the system and marketing their products has continued down through the years. As the old saying goes, what goes around comes around. For example, Merck Medco later wound up in legal trouble of its own. In 2004, the company settled lawsuits brought by 20 states alleging that the company failed to disclose those "incentives" they received from drug companies - echoes of the rebates deal with Purdue. The company was charged with improperly switching or "pressuring" doctors to change patients' medications "in pursuit of profit." In 2005, Medco agreed to pay the United States $155 million plus interest to settle allegations that it defrauded the government. Drugmaker Merck & Co. spun off its Merck Medco benefits management company in 2003, but was hit with legal problems of its own in 2008. Merck agreed to pay the Department of Justice more than $650 million for Medicare fraud and kickbacks - or as the DOJ said, "to resolve allegations" that the company "failed to pay proper rebates to Medicaid and other government health care programs and paid illegal remuneration to health care providers to induce them to prescribe the company's products." Interestingly, that figure of $650 million is almost the same amount that Purdue Pharma paid in all to the Department of Justice in 2007 after being charged with "off-label promotion" and making false claims for its OxyContin painkiller. In spite of these and many other state and federal lawsuits over the past decade, we are still battling the opioid addiction epidemic .

Novus Medical Detox Center continues to play a pivotal role in helping victims of that epidemic recover their lives.

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