Founder of pharmaceutical company indicted for bribing doctors to prescribe opioids

Founder of pharmaceutical company indicted for bribing doctors to prescribe opioids

As federal and state officials sound the alarm about opioid abuse, Illinois lawmakers should take steps to root it out of the workers’ compensation system.

John Kapoor, the billionaire board chairman of Lake Forest-based Akorn Pharmaceuticals and founder of Arizona-based pharmaceutical manufacturer Insys Therapeutics Inc., has been charged by federal prosecutors with leading a nationwide conspiracy to bribe doctors to prescribe his company’s opioid painkiller, according to the Chicago Tribune.

This is just the latest trouble for Insys, which settled a lawsuit with the state of Illinois for $4.45 million in August. Illinois Attorney General Lisa Madigan sued Insys in 2016, alleging the company deceptively marketed and sold Subsys, a fentanyl spray advertised on its site as providing relief for “breakthrough cancer pain,” to doctors for off-label uses, according to Reuters.

The federal indictment also charges Kapoor and other defendants with insurance fraud for their efforts to get insurance companies to cover prescriptions for Subsys for patients who did not have cancer. Other Insys personnel, such as the firm’s former CEO, five other former executives and at least two sales representatives have faced charges for using speaker fees and marketing events to bribe doctors to prescribe Insys’ cancer-pain-relief drug to non-cancer patients. Boston-based Acting U.S. Attorney William D. Weinrib said federal officials indicted Kapoor pursuant to “ongoing efforts to attack the opioid crisis from all angles,” according to the Tribune.

The gravity of the opioid crisis caused President Donald Trump in October to officially declare it a public health emergency. The Centers for Disease Control and Prevention, or CDC, notes on its site that in 2014, “almost 2 million Americans abused or were dependent on prescription opioids.”

Opioid-related risks in Illinois’ workers’ compensation system

The opioid epidemic has taken its toll on Illinoisans, too. Data from the Illinois Department of Public Health, or DPH, show 2,278 drug-related overdose deaths occurred in Illinois in 2016, up 44 percent from 2013. Of those drug overdose deaths, 80 percent were opioid-related, according to DPH data.

Yet despite the dangers of opioid abuse, Illinois lawmakers still have not addressed a feature of Illinois’ workers’ compensation system that has been shown to increase the risk that an injured worker will receive an unnecessary prescription for a potentially dangerous opioid painkiller.

Rather than requiring injured workers to fill their prescriptions at a pharmacy, Illinois’ workers’ compensation system allows physicians to dispense drugs directly to patients – a practice that has been shown to increase workers’ compensation costs, workers’ time off the job and the amount of opioids prescribed to injured workers.

According to a study by Johns Hopkins University researchers of workers’ compensation claims opened and closed between 2007 and 2012, physician dispensing in Illinois’ workers’ compensation system resulted in doctors writing more than three times the number of opioid prescriptions they write when a pharmacy dispenses the medication. This study also showed that costs increased dramatically in cases in which physicians dispensed medication rather than having patients fill prescriptions at a pharmacy.

In 2011, Illinois lawmakers enacted workers’ compensation reforms to try to rein in costs, including those due to physician dispensing of medication. But loopholes remained, and post-reform, the percentage of workers’ compensation prescription costs attributed to physician-dispensed drugs actually rose in Illinois, according to a 2017 study by the Workers Compensation Research Institute, or WCRI.

The WCRI study’s authors concluded that the high percentage of prescription prices in Illinois attributable to physician dispensing was due to “frequent physician dispensing of higher-priced new drug products.”

Several of the “new” drug products physicians had begun dispensing were actually existing drugs formulated by manufacturers with different strengths and assigned prices that were far higher than those for existing-strength medications. Among the new-strength drugs were the opioid painkiller 150 milligram tramadol extended release and 2.5-325 milligram hydrocodone-acetaminophen (an opioid painkiller of which Vicodin is a well-known brand).

The WCRI study authors noted these new-strength drugs were seen almost exclusively in physician-dispensed prescriptions, and not in prescriptions filled in pharmacies. That suggests motives other than patient well-being were likely at play in prescribing the new, more expensive drugs.

Thus, the loopholes in Illinois’ workers’ compensation system continue to drive up costs while threatening worker safety.

Illinois bill to reform physician dispensing never made it to full House vote

In February, state Rep. Barbara Wheeler, R-Crystal Lake, filed a bill to close the loophole in Illinois’ workers’ compensation system that provides incentives for some doctors to overprescribe certain medications. House Bill 2892 would deny reimbursement under the Illinois Workers’ Compensation Act for prescriptions “filled and dispensed outside of a licensed pharmacy.” The bill makes a narrow exception for direct dispensing of medication in cases where a licensed pharmacy is more than 5 miles from the doctor’s office. In those cases, a doctor will be reimbursed only for a supply of medication that lasts for the greater of “72 hours from the date of the injury or 24 hours from the date of first referral to the medical service provider.” The bill would also allow prescriptions to be filled outside of a licensed pharmacy in cases in which a preferred provider program’s agreement with a physician provides for this.

Reasonable reforms such as Wheeler’s ensure injured workers in need of pain medication can still have their prescriptions filled at a licensed pharmacy. Her bill simply protects injured workers by limiting doctors’ ability to sell those drugs directly within the workers’ compensation system.

Notwithstanding Illinois’ mounting opioid crisis, high workers’ compensation costs and the risk that physician dispensing can pose to injured workers – as well as the extra costs this practice imposes on taxpayers, who pay for workers’ compensation for government employees – this commonsense reform never made it to a vote on the House floor.

Federal and state officials have sounded the alarm about opioid abuse. It’s time Illinois lawmakers address potentially contributing factors in the workers’ compensation system. Passing HB 2892 would be a good start.

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