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May 17, 2007

Psychotic Reactions And Medicaid: One Man's Quest To Learn The Truth

Meet Ben Hansen.


A self-styled mental health advocate, the Michigan resident two years ago was a member of the state's Department of Community Health Recipient Rights Advisory Committee, which oversees Medicaid and foster care programs. That's where he learned of a program financed by Eli Lilly, which sells the popular Zyprexa antipsychotic.

This effort was established to monitor Medicaid prescribing data, so docs don't waste state money on mental illness drugs. But there are strings attached - Lilly's aid is free, but only if a state lets docs prescribe Zyprexa without first seeking permission from the state.

Concerned about Lilly's influence, Ben began an odyssey that has pitted him against big government and big pharma. He sought info about psychiatric prescribing patterns, but was rebuffed. Then, he filed Freedom of Information requests, and received dribs and drabs.

For instance, he did receive a memo showing a Lilly rep wanted to participate in planning sessions and have other reps speak with doctors, which he provided to The New York Times. And Hansen also got data showing that, in 2005, there were 3,064 scrips issued to kids ages four and under, for antidepressants, ADHD pills and antipsychotics.

But he's still fighting a court battle to obtain more specific info about the individual drugs prescribed, particularly antipsychotics, and the exact ages of children who received the drugs. This is a hot issue - the atypical antipsychotics, which include Risperdal, Seroquel, Zyprexa, Abilify and Geodon, aren't approved by the FDA for youngsters.

And this an issue for taxpayers, since Medicaid is paying for those drugs. And it's not just in Michigan. In Minnesota, for instance, spending on antipsychotics for kids on Medicaid grew 14 times between 2000 and 2005, to more than $7.1 million, The New York Times reported.

A study in Texas of Medicaid data found so many children being prescribed these meds that the state established strict guidelines in dispensing drugs to children. Meanwhile, other self-styled activists are tracking prescribing patterns in other states, such as New Jersey and Florida, and claim they've obtained data from state agencies indicating large numbers of antipsychotic prescriptions written for kids covered by Medicaid programs.

Of course, doctors are free to prescribe off-label, and they do so because antipsychotics are known to mitigate extreme behavior. Between 2001 and 2006, the rate at which girls between 10 and 19 years old took antipsychotics rose 117 percent. For boys, the rate was 71 percent, reports Medco, the PBM. Meanwhile, as usage rose, so did the number of deaths and serious side effects reported to the FDA, The Times noted.

But the prescribing trends raise questions about the extent to which drugmakers may be influencing this behavior. Already, several states are investigating whether Lilly hid side-effect info about diabetes and weight gain associated with Zyprexa. As one law-enforcement source says of Medicaid and off-label use: "This is an area to keep your eye on."

Hansen, meanwhile, is still battling in court. Earlier this month, a judge granted Michigan's motion to dismiss his lawsuit and ordered him to pay $3,500 in court costs. But he insists he will file an appeal.

"When this fight began, I didn't fully realize how high the stakes were, and I didn't understand why our opponents were putting up such fierce resistance. What's the big deal, if all we're asking for is a list of drug names? Why would the other side be so determined to keep this information hidden from the public? After all, Eli Lilly's sales rrep not only sees the list, but literally sits at the table while the data is reviewed. Surely the taxpayers who foot the bill for these drugs should have the same rights as a drug company sales rep, shouldn't they?"

You can read more here.

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Ben Hansen says:

Thanks Pharmalot, for publicizing my ongoing battle with the State of Michigan and Eli Lilly.

On the subject of antipsychotic drugs and children, here's some interesting data from the Florida Council for Community Mental Health:

Diagnoses of Children Receiving Antipsychotic Medications, 2005-06.
ADHD 38%
Affective Disorder 19%
Conduct Disorder 10%
Major Depression 8%
Schizophrenia/psychosis 8%
Autism 4.4%
Adjustment Disorder 3%

This was a shock to me, to learn that ADHD tops the list.

Ben Hansen
Traverse City, Michigan

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