Feb
1

Big pharma’s “not responsible” for the Opioid Disaster

Opioid manufacturers and distributors are “lobbying up”, spending almost $2.5 million dollars to lobby state Attorneys General over the last three years, likely in an effort to convince them to not sue manufacturers.

These millions allow manufacturers and distributors access to Attorney General meetings, where CBS reported their representatives spoke “on a panel, telling a group that they were not responsible for the opioid crisis, according to several attendees.”

Overa ten years, these distributors and manufacturers sent 21 million pills to a single West Virginia town, a town with a population of 2900 souls.

That’s around 462 tons of pills.

320 pounds of opioids for every person in Williamson, WV.

Two independent pharmacies – just a quarter mile apart – each got more than a million pills a year. The explanation offered by one of the pharmacies – that the pharmacy serves a much bigger area than just the town of Williamson – is beyond ludicrous. The entire county’s population is less than 27,000.

It gets worse…this from Gizmodo…

An investigation by the Charleston Gazette-Mail found in 2016 that almost 800 million hydrocodone and oxycodone pills were distributed throughout the state’s pharmacies from 2007 to 2012—a figure all the more astounding given that the state has only 1.8 million residents. [emphasis added]

That’s more than 400 pills for every man, woman, and child.

BTW, Purdue Pharma has made $35 billion from sales of Oxycontin.

How in the hell can distributors claim they are “not responsible for the opioid crisis” when distributors sent 2 million opioid pills a year to 2 pharmacies in a tiny town?

A new paper from University of Virginia researcher Christopher Rhum discounts many of the factors blamed by some for the huge spike in drug deaths, placing the blame squarely on the supply of opioids. According to The Economist, “The epidemic is caused by access to drugs rather than economic conditions.”

Of note, the owner of one of the Williamson pharmacies was quoted saying: ““All the prescriptions we filled were legal prescriptions written by a licensed provider,”

Tomorrow, an interview with a licensed provider.

Thanks to Liz Carey of WorkersCompensation.com for her story on this.


Jan
15

So much for the “Opioid Crisis”

A 24-year old is acting as chief of staff of the Office of National Drug Control Policy.

Of course he has no experience, qualifications, or background that qualifies him for this role. And, ts ONDCP has no Director or Chief of Staff, this kid has been one of, if not the, senior executives at the federal agency tasked with addressing the opioid crisis.

Taylor Weyeneth, who happens to be from our town, also submitted a resume to the federal government that exaggerated his “credentials” (he claimed a graduate degree he does not have).

According to newspaper reports, he was involved with a “family company” here that federal records show was “secretly processing illegal steroids from China as part of a conspiracy involving people from Virginia, California and elsewhere.” Weyeneth’s resume claims he was head of production for this company when he was 16.

Weyeneth is the symptom, the Administration’s complete lack of attention to the opioid crisis is the problem.

This personnel debacle follows the Administration’s attempt to appoint Tom Marino as Director of ONDCP. Marino is a politician that sponsored a bill greatly limiting federal oversight of the opioid industry. an attempt that fortunately collapsed amidst bi-partisan outrage.

Seven Administration appointees have left the Office over the last year; that’s more than 10 percent turnover in the 65 person office. There is no Director in place, and no indication there are any plans to appoint one.

The President gives speeches about the crisis, and claims the Administration is doing everything possible to attack the drug crisis – and Taylor Weyeneth is appointed Deputy Chief of Staff.

Words are one thing, actions another.

What does this mean for you?

We aren’t going to get any help from the White House on opioids.

 


Jan
3

The greatest health “system” in the world

Is responsible for a two-year decline in life expectancy.

Make no mistake, the profit motive embedded in the US healthcare system is directly responsible for an unprecedented drop in life expectancy; opioid manufacturers’ and distributors’ focus on profits coupled with lax governmental oversight led to the opioid disaster.

So, 42,000 of your kids, neighbors, friends, relatives, co-workers died from opioids last year.

But fear not, the addiction treatment industry is riding to the rescue.  Funded by your insurance premiums and tax dollars, a plethora of “treatment” centers are popping up.  While some are excellent, many are nothing more than “treatment mills”, operations set up to suck as many dollars as possible from patients, taxpayers and insurers. Once the dollars run out, the patients are kicked to the curb.

Here’s one example…

The schemes are many, with treatment mills paying body brokers to recruit addicts, false addresses to ensure insurance coverage, fake credentials for “clinicians” and huge bills for non-existent services.

The next time some uninformed individual starts babbling about the exceptionalism of the American healthcare “system”, stick this under his/her nose – we’re exceptional at creating addicts, killing people, lowering life expectancy, crushing souls, while making huge profits for investors legitimate and not.

What’s the solution? 

We pay more for healthcare than anyone else in the world, dollars that are diverted from education, job creation, infrastructure. Many of these dollars are well spent, but the opioid treadmill is just one example of waste and fraud.

A good start would be to much more aggressively prosecute the opioid shills and their buddies in the “treatment” business.  Long and hard jail time for the executives and investors would help prevent the next disaster, but the $209 million in lobbying dollars spent last year by the pharma and device industry makes that unlikely at best.

You get the government you deserve, and you deserve to get it good and hard. HL Mencken.

 

 


Nov
30

Comp is getting it done on opioids.

Work comp drug costs are down 22% over the last five years.  Opioid spend dropped 16.7% last year.

That’s the key takeaway from CompPharma’s annual survey of Prescription Drug Management in Workers’ Comp.

These are truly remarkable results; payers and PBMs (mostly PBMs) have slashed over a billion dollars from pharmacy spend, cutting costs for employers and taxpayers.

There is much left to do; far too many patients still get far too many drugs. Opioid addiction is a crisis in workers’ comp, as is abuse misuse and diversion. There are still no comprehensive, completely (or even mostly) effective tools/medications/programs to help patients get off and stay off opioids.

But let’s focus on the positive. Last year, overall opioid spend in the US declined by 1 percent – while work comp cut opioid spend by almost 17 percent.

While the reduction is beyond substantial, it’s important to understand that a big chunk of this was driven by payers settling older claims, claims that have a disproportionately high drug spend. These settlements don’t “count” towards drug spend, while they do eliminate on-going dispensing and the attendant costs.

What does this mean for you?

Well done.

 


Nov
27

Purdue Pharma’s attempting to settle all state claims

Things must be getting tense in Stamford CT, headquarters of Purdue Pharma.  Reports indicate Purdue is working on a deal to resolve all state claims related to opioids.  

Remember – Oxycontin revenues to date are $31 billion and counting. 

Reports indicate Purdue’s owners, the Sackler family, have a net worth of around $14 billion.

Here’s what we’ve read so far about the legal situation:

A couple of factoids to remind us of the cause and effect of Purdue’s strategy.

So, what does this mean?

For workers’ comp payers, it is time to get together and develop a legal strategy and approach to suing opioid marketers. The human and financial damage caused by Purdue, Endo and their ilk is incalculable and continuing to grow. Without a successful legal action, employers and taxpayers will be footing the bills for decades to come.

There’s a deeper and even more troubling aspect to this.  One could argue – and with a lot of supporting data – that pharma companies figured out a way to legally addict people and get their insurance companies to pay for their drugs. 

There is no more damning indictment of the profit motive in the US healthcare system.

What does this mean for you?

Time to get moving.

 

 

 


Oct
16

Run like hell…

Shockingly, compound drug fraudsters allegedly lied when they sold accounts receivable to investors.

Who’da thunk it?

Thanks to Greg Jones for his excellent investigative reporting on this; Greg reports today that:

Exhibits filed in the lawsuit by Shadow Tree Investment against Praxsyn Corp. reveals connections to three providers accused of accepting kickbacks from other compounding pharmacies. Praxsyn owns Mesa Pharmacy in Irvine, California.

Mesa was partnering with three providers who now face criminal charges for accepting kickbacks to prescribe compound drugs to injured workers.

The basis for the case appears to be Praxsyn allegedly didn’t tell Shadow Tree about pertinent details about the A/R deal…details such as the accusations about the source of the bills, the alleged nefarious activities of some of the parties involved, and relevant lien settlement information.

I was peripherally involved in something similar to this, when a compounding company was trying to sell its receivables a couple of potential buyers called me for my opinions.

Which, briefly summarized, were “run like hell.”

What does this mean for you?

That remains good advice for anyone approached by compounders, physician prescribing companies, and so-called “revenue cycle management firms” doing most of their work in these areas.

 


Sep
22

Opioids responsible for a fifth of the decline in male workforce

That’s a conclusion, albeit one with caveats, of a just-released study by Princeton University’s Alan Krueger PhD.

Here’s Dr Krueger’s key takeaway, with emphasis added:

about half of prime age men who are not in the labor force (NLF) may have a serious health condition that is a barrier to work. Nearly half of prime age NLF men take pain medication on a daily basis, and in nearly two-thirds of these cases they take prescription pain medication.

Labor force participation has fallen more in areas where relatively more opioid pain medication is prescribed, causing the problem of depressed labor force participation and the opioid crisis to become intertwined.

Implications abound.

For workers comp – despite unprecedented drops in opioid prescriptions for work comp patients, there remains a large population of patients addicted to/dependent on opioids. Moving this population away from opioids will require diverse, creative, and likely expensive services, patience, and persistence.

For the economy – a double whammy of non-productive people means they aren’t generating tax and revenues while consuming lots of resources in the form of aid, government funds, healthcare services, and family income.

For health plans, especially those serving the indigent, a very expensive, and very tough to manage population will increase Medicaid costs significantly.

For opioid manufacturers, shiploads of cash.


Sep
7

Thursday catch-up

Genex acquires Prium…

Good move by Genex, as Prium’s portfolio of services including physician review and pharmacy management ties in well to Genex’ current offerings. I’m a big fan of Prium CEO Michael Gavin – he’s one of the most thoughtful, intelligent, and measured people in our business…good news is he’s sticking around.

Kentucky’s making big progress on opioids

Thanks to WCRI’s Vennela Thumula PharmD for her study on how new legislation (HB-1) helped to reduce the number of new work comp patients receiving opioids.

The legislation required prescribers to check the Prescription Drug Monitoring database prior to prescribing opioids, limited opioid prescriptions, and implemented mandatory educational and patient treatment practices.

Key Takeaways

HB-1 immediately reduced opioids prescribed to patients in the first 12 months after the date of injury.

Both the percentage of patients receiving opioids and the amount of opioids decreased by more than 15 percentage points.

Major surgical patients weren’t significantly affected by HB-1; not much change in prescribing to these folks.

Patients with back sprains and similar diagnoses had far fewer opioid scripts.

Thanks to Andrew Kenneally, Communications Director of WCRI, for the head’s up…

Opioid marketing practices

Kudos to Sen Claire McCaskill, D MO, for publicizing opioid manufacturer Insys’ alleged efforts to get approval for fentanyl product Subsys through misrepresentation. McCaskill’s report included an:

audio recording of conversations between an Insys employee and pharmacy benefit manager representatives related to a Subsys prescription for Sarah Fuller, who later died from an alleged fentanyl overdose. This recording suggests the Insys employee in question repeatedly misled Envision Pharmaceutical Services to obtain approval for Ms. Fuller’s Subsys treatment—heavily implying she was employed by the prescribing physician and misrepresenting the type of pain the patient was experiencing.

Sarah Fuller

This follows other reports of Subsys’ unethical and potentially illegal marketing practices, where other Subsys reps said they called payers, saying they were from doctors’ offices and were seeking approval for the drug.

Hell is too cold for these people. 

Finally, a very revealing piece in HealthAffairs provides more insight into just how powerful big healthplans are:

insurers with market shares of 15 percent or more (average: 24.5 percent)…negotiated prices for office visits that were 21 percent lower than prices negotiated by insurers with shares of less than 5 percent.

Differences in providers’ and insurers’ bargaining power are a major contributor to variation in commercial health care prices

Workers’ comp folks – you’re lucky if a generalist work comp PPO’s market share at a practice is 3 percent…

Back out onto the campaign trail!


Aug
25

There’s no BIG problem in work comp pharmacy – and that’s scary.

In the fourteen years I’ve been surveying work comp payers on their views on pharmacy, I’ve never seen so little consensus among respondents on emerging issues.

In past years compounds, physician dispensing, opioids, price inflation, and new drug introductions have all been named by at least a plurality of respondents. Not so this year.

Here are some of the 24 respondents’ concerns:

legalization of marijuana – lots of talk about it but concern is what do you do about it, how do you handle it, pay for it, authorize it, etc. so many unknowns and little understanding
state regulations and how to bring information on those changed regulations and how to operate under the new regs back to adjusters and case managers at the desk level and to PBMs
I’m concerned we’ll see branded topicals increasing over the next few years despite a lack of efficacy and inflated prices. teracyn, speedgel, etc aren’t useful
advent of all new formularies, no one has grappled with legacy claims in that environment, thinking is formularies will get docs to taper it off – docs who prescribe all this don’t know how to taper, so finding the right docs and facilities is a real issue for legacy claims
acquisition of comp pbms and consolidation of the work comp PBM industry
Physician Dispensed Drugs and non-controlled home delivery – not just cost but formulary and safety and quality of care
what interventions can they do to to affect drug pricing, especially some of the drugs that have minimal alternatives
more problematic than opioids is the combination of benzodiazepines and sleep aids
watching very closely Evzio, naloxone prescribing practices as part of CDC
still a soft market so anything you can do to reduce costs is important

While payers are seeing good success in reducing opioid utilization and total drug spend, there are a host of troubling issues out there.

Here’s why this is a big issue.

Payers are all too used to getting screwed by unethical and very creative profiteers intent on sucking money away from employers and taxpayers by exploiting loopholes. Branded topicals, “independent” mail order pharmacies and novel drugs are all great examples of these tactics, often hidden under and supported by claims that these promote healing and health despite a total lack of supporting evidence.

In past years when doctor dispensing, the opioid crisis, or compounds were top-of-mind for most respondents, the industry joined together to come up with solutions. That obviously isn’t the case today, leaving patients exposed to crappy providers interested only in profits coming up with myriad ways to game the system.

What does this mean for you?

It’s not the one big problem that’ll get you, it’s the many small ones you may not even notice.


Aug
23

Big news in work comp pharmacy

Finishing up the Annual Survey of Prescription Drug Management in Workers’ Comp this week (I hope!).  24 payers responded this year – TPAs, Insurers, State funds, and very large employers. Each provided specific data about their pharmacy programs, data which provides remarkable insights into what’s really going on.

Something jumped out at me that I had to get out immediately…

Two big takeaways – drug spend dropped by almost 10 percent…

while opioid spend decreased even more – almost 14 percent.

Wrap your head around that.

Work comp PBMs and payers succeeded in eliminating one of every seven dollars spent on opioids; yes, overall drug spend was down a full 10 percent, driven in large part by lower utilization of opioids.

When opioids are eliminated, the drugs needed to counteract their awful side effects – everything from constipation to sexual dysfunction to gastrointestinal distress to depression – are reduced as well.

The programs, processes, analytical resources, clinical staff, research, and patient outreach that’s driven this stunning result are largely PBM-delivered (with some notable exceptions).  These services are clearly improving the quality of care delivered to work comp patients, while reducing costs for employers and taxpayers.

shipload of opioids has been taken out of circulation, eliminating the possibility of diversion, misuse, or abuse.

What does this mean for you?

Healthier patients, lower costs, reduced disability.