Articles Posted in Pharma

MedicareJesimya David Scherer-Radcliffe, 21, passed away just a month after the loss of his health insurance forced him to begin rationing insulin to treat his diabetes. However, Scherer-Radcliff’s death is not the only of its kind, with insulin prices doubling from 2012 to 2016 causing many individuals to ration the drug.

Why have insulin prices grown exponentially over the past few years? There is no single reason, other than the privatization of America’s health care system which has allowed this practice to become standard. Many experts place the blame on large pharmaceutical companies and pharmacy benefit managers (PBMs) like CVS Health. PBMs regularly work with pharmaceutical companies in an effort to reduce the costs of various prescriptions through health insurance, but this reduced cost can result in higher out-of-pocket expenses for those without health insurance.

“Every time a PBM extracts a deeper discount, an insulin manufacturer has the incentive to take a price increase to quote ‘make themselves whole,’” stated Rena Conti, a health economist.

big-pharma-300x196Jazz Pharma, Alexion, and Lundbeck were the subject of SOJ lawsuits asserting kickbacks and committing general violations of Medicare laws. The United States Department of Justice has decided to agree to a settlement of $122.6 million in total from these three alleged Medicare violators.

The drug companies were accused of offering remuneration in hopes of encouraging patients to purchase their medications. They would pay kickbacks, a form of negotiated bribery, to patients of Medicare and Civilian Health and Medical Program (ChampVA) under the guise of charitable organizations that subsidized the co-pays. This is not an uncommon practice, but it is one many law enforcement programs are attempting to discontinue.

The DOJ states that in this case, the companies violated the Federal False Claims Act. This act is a way of imposing liability onto anyone, be it a group or individual, that has been discovered interfering with government-funded programs such as in this case with Medicare. This is one of the government’s main tools in defending against fraudulent acts.

prescription drugsWith the increased frustration regarding inflated prescription drug prices, states like Florida are pushing for legislative programs that would permit the United States to import drugs from Canada. If this bill were to pass, it would allow many of the identical prescription drugs consumed by Americans to be purchased for a third of the price. However, this is not the first time a bill of this nature has been attempted.

In Utah, a similar bill that would have allowed the state to import prescription drugs from Canada was eventually turned down after lawmakers spent two-years developing the legislation. However, representatives in the state of Utah have not given up and claim that they will try a variation of the bill again next year. Leading the original legislation, as well as the upcoming bill is Republican Representative Norman Thurston.

However, the state of Florida is the next in the line to attempt to pass a similar version of this bill, which would permit the importation of prescription drugs for both Medicaid and prisoners. If passed, an additional program of the legislation would also allow the importation of these products for residents of the state.

insulinEli Lilly, a pharmaceutical giant known for their rapid-acting insulin, Humalog, has officially decided to release a generic version of insulin that will be nearly half the price of its name-brand product.

Not long before this announcement, many pharmaceutical leaders were gathered in order to discuss the issue concerning confusingly high drug prices. One of the main targets of this debate was the increase in pricing for insulin, in which people who have diabetes have been drastically rationing due to their inability to afford what they need to survive.

Humalog, one of the nation’s more expensive insulin options, has had a big increase in their cost over the years. Senator Ron Wyden states, “The list price of Eli Lilly’s main insulin drug, Humalog, went from $21 a vial in 1996 to its current list price of $275.” He then continues to question these actions by stating that, “Humalog isn’t thirteen times as effective as it used to be… A vial doesn’t last thirteen times longer than it did in 1996.”.

Pharmacy fraudHolly Blakely, a former San Antonio pharmaceutical rep in Texas, plead guilty and confessed her involvement in an $8.8 million healthcare fraud scheme.

Initially, Holly Blakely was charged in a 30-count indictment. This allegedly means that she paid more than $400,000 in bribes and kickbacks to clinicians for prescribing compounded medications. Compound medication is basically personalized medications produced in order to fit an individual’s exact medical needs. In this case, these compound medications, in particular, were designed to ease pain, but the people these were being given to did not require them.

Blakely confessed that she worked with two compounding pharmacies in order to push prescriptions for compound drugs. The pharmacies would then submit claims to health plans such as Tricare. In exchange for her part of the fraud, Blakely was paid $1.15 million.

kickbacksIn 2009, the company Eli Lilly & Co. plead guilty to illegally marketing an antipsychotic drug, Zyprexa, for unapproved uses on patients, leading to a fine of $1.42 billion. This settlement ended a series of civil lawsuits, as well as a criminal investigation. At the time this large of a settlement was unheard of, but how did the company orchestrate such a massive kickback scheme?

The Kickback Scheme

Originally, Zyprexa was approved for a very narrow use of schizophrenia and bipolar disorder, however Eli Lilly & Co. soon began to market the drug for a variety of other purposes. In fact, it was alleged that Zyprexa was eventually marketed to treat dementia, and was even prescribed for illnesses related to pediatrics in high doses. The company was also accused of overcharging for the drug. This allowed the company to target a significantly wider audience, increasing their potential profits on the drug exponentially.

Insys TherapeuticsA former Insys Therapeutics executive, accused in an opioid bribe scheme, may have once gifted a lap dance to a doctor the company was pressuring to prescribe opioids drugs to patients. The troubling allegations are emerging as part of Insys trial in Boston.

Jurors heard the “lap dance” testimony on the second day of the federal trial in Boston against Insys Therapeutics founder, John Kapoor, and four other former executives. Apparently, Sunrise Lee, was a former exotic dancer with no experience in pharmaceuticals, who was hired to be a regional sales manager.

Holly Brown, a former Insys sales representative, testified that her superiors encouraged her and others of the sale team to focus their attention on a specific doctor who was known for prescribing a high amount of opioids, named Dr. Paul Madison. She says at one party she saw Lee sitting on Madison’s lap and “bouncing around,” with Madison’s hands “inappropriately all over” Lee’s chest. The prosecutors say this was part of an opioid bribe scheme.

tax havenThe Sackler family empire comprises Purdue in America, Napp in Britain, and Mundipharma in Europe and Australasia. The companies have helped amass a £10 billion fortune, protected, in part, by the tax haven of Bermuda.

The Evening Standard in the UK released a report detailing that while their opioid painkillers are manufactured in Cambridge, the Caribbean is actually the heart of the Sacklers’ tax avoidance strategy. They report the Sackler family has allegedly diverted billions of pounds in profit to Bermuda to avoid paying millions in taxes that would have been due to the UK or Europe.

The Investigation into Opioid Companies

pharmacy-fraud-300x199The pharmaceutical industry in Pasadena is much like the rest of the United States. There are certainly an influx of individuals who receive Medicare using these services for particular ailments and diseases that accompany being older than 65 years old. However, a local Pasadena pharmacy, Akhtamar Pharmacy, was abusing the Medicare funds provided for those particular individuals. Although the pharmacy owner did not act alone, she was able to steal $1.3 million dollars from the Medicare system.

Pasadena Pharmacy Owner Convicted for Medicare Fraud

Although the pharmaceutical industry is driven by a purpose to help those who need medication, it can also be a place for fraudulent acts to occur. With so much paperwork to be completed, many individuals find themselves taking advantage of the system by falsifying numbers or providing inaccurate invoices. Unfortunately, this was the case in a Pasadena pharmacy. A 39-year-old pharmacy owner, Tamar Tatarian, was convicted on one count of healthcare fraud and two counts of wire fraud at Akhtamar Pharmacy in Pasadena. It is believed that she committed the fraudulent acts which amounted to $1.3 million dollars in total.

dangerous-waste-300x200One of the world’s largest drug manufacturing locations is becoming the center of a raging debate about the cost of good jobs versus safe drinking water. Hyderabad, India has become an economic center thanks to drug companies setting up shop. But alarming new reports say the monetary boost for the locals and big pharma has a hefty environmental price tag: pharmaceutical waste.

Pharmaceutical Waste Study

According to Technology Networks, drug companies in Hyderabad are dumping “untreated or inappropriately treated pharmaceutical waste into the environment.” There are several laws and regulations in place that detail how these drug manufacturers are supposed to treat waste, but a 2016 study highlighted that the companies were not following the guidelines.