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Is there a fox in the Medicaid henhouse?
Anne Stanton

“Incestuous relationship” between State and Eli Lilly
targets children and boosts drug sales, critic charges

Giant drug maker Eli Lilly is now overseeing a “quality” management program of 20 state Medicaid programs throughout the country, and Michigan is one of them.
Critics question whether it’s one more way for the company to market its psychiatric drugs, but Eli Lilly said its program ensures drugs are dispensed safely. For context, nearly 90% of antipsychotics sold in this country are paid for by government programs, including Medicaid.

To run Michigan’s program, Eli Lilly gives a “grant” of up to $1.8 million per year to a consulting company called Comprehensive NeuroScience Inc. (CNS).
Each month, CNS takes mounds of Michigan Medicaid prescription drug data and determines whether there are any problems, such as:
- Two doctors prescribing the same patient the same class of drug;
- A patient taking three or more of the same class of drugs, such as an antidepressant;
- A doctor prescribing below or above the recommended dose.
If CNS finds such a problem, it sends out a “Dear Doctor” letter asking for compliance, which is voluntary, said Eli Lilly spokeswoman Janice Chavers.
Chavers said the program is a way for Eli Lilly to “give back” to patients.
“It’s that simple. We’re all about patient health care. We invest millions and millions of dollars to enhance patient care.”
The program, the Pharmacy Quality Improvement Project (PQIP), has saved Medicaid 21 percent in costs and a 22 percent reduction in claims since the program was instituted in May of 2005, according to a press release issued by T.J. Bucholz, spokesman for the Michigan Department of Community Health, which oversees Medicaid.
But Bucholz was unable to provide the dollar figures behind those percentages.
Nevertheless, if taxpayers don’t pay a dime, and poor, mentally ill patients have someone looking out after them, what’s the problem?

Traverse City activist Ben Hansen provided Northern Express with the PQIP data, obtained through his Freedom of Information Act request, after charging that the state “cherry picked” its numbers for its press release.
An analysis of the PQIP data shows that:
- The number of patients under the age of 18 increased from 55,448 in June of 2004 to 66,411 in October of 2006. The cost to taxpayers jumped by more than $5 million -- from $13.6 million to $18.9 million.
- The number of adults on psychiatric drugs slightly increased: from 169,432 in January of 2006 to 170,310 in October of 2006. The state ended up paying $6.6 million more for claims ($39.5 to $46.1 million), although the figures are substantially down from 2005 claim costs of $71 million.
- Patients with high-risk behaviors (the very type of problem the program is trying to solve) rose from 9,926 to 11,994 from January 2006 to October 2006.

The data shows the number of adult patients has remained steady at around 170,000 since 2004, while the number of children taking psychiatric drugs has increased from 55,000 in 2004 to an average of 70,000 in 2006.
“That seems to support my allegation that young children are being targeted by the pharmaceutical industry,” Hansen said. “What’s so disgusting is that PQIP’s stated goals are worthy, but they’re not doing what they’re set up to do. They’re doing the exact opposite! There’s no question that we need to monitor the prescribing patterns and that we ought to keep track of what kind of drugs we’re giving to our children. But Eli Lilly is using this program to expand their share of the lucrative Medicaid market.”

Hansen has filed suit over the release of two specific CNS reports: 1) Children Under Age five, listing drugs by name; and
2) Patients on five or more psychotropics, listing drugs by name.
Hansen is particularly concerned by the state’s refusal to release the data for children under age five. That’s because CNS reports from 2004 and 2005 show a 100% increase in the “under five” category. 
CNS stopped issuing separate reports for the under-five age group in 2006.  “I have no idea if psychiatric prescriptions to children under age five increased by another 100 percent in 2006. The state won’t tell me. Now I’m looking at $3,500 in court fines simply because I asked some questions the state doesn’t want to answer,” Hansen said.

A New York Times article published on the topic last month points out that the program comes with “strings attached.” Eli Lilly doesn’t do business with any Medicaid state department that requires doctors to seek permission for prescribing an atypical antipsychotic.
That’s important to Eli Lilly because its blockbuster drug is Zyprexa, an atypical antipsychotic.
Zyprexa has been the poster child of controversy. The New York Times recently reported that a court ordered “Eli Lilly to pay up to $500 million to settle claims for 18,000 lawsuits from people who claimed they developed diabetes or other diseases after taking Zyprexa, Lilly’s drug for schizophrenia and bipolar disorder.”  Zyprexa causes weight gain, high blood sugar levels, and diabetes more than many of its competitors, according to the American Diabetes Association.
“Documents provided to The New York Times last month by a lawyer who represents mentally ill patients show that Lilly played down the risks of Zyprexa to doctors as the drug’s sales soared after its introduction in 1996. The internal documents show that Lilly’s own clinical trials found that 16 percent of people taking Zyprexa gained more than 66 pounds after a year on the drug, a far higher figure than the company disclosed to doctors,” according to an article in the paper.

Yet Medicaid departments nationally spent $1.3 billion on Zyprexa in 2005.
“Eli Lilly loves Zyprexa because it happens to cause the disease that’s the fastest growing sector of Lilly’s product portfolio: diabetes products like Byetta, Actos, Humalog, and Humalin. Good Lord! Talk about evil!” Hansen said.
In the New York Times’ report, Hansen called the partnership between Eli Lilly and Medicaid “incestuous.”
“When the line between business and government becomes nonexistent, bad things result. Do we really want policy decisions about our heath care to be determined by the bottom line of a corporate spreadsheet?”
The partnership between Eli Lilly and Wisconsin’s Medicaid program came to an end after the state instituted a new policy that required doctors to seek permission before prescribing atypical antipsychotics.
Since then, Wisconsin said its spending on atypical antipsychotics dropped by $4 million, according to the New York Times.

Eli Lilly’s “grant” to CNS of up to $1.8 million per year appears to be a ticket price for Eli Lilly to sit in on monthly PQIP meetings. Hansen, through his FOIA request, learned that Molly Bodenschatz, an Eli Lilly account executive, attended every PQIP workgroup meeting in 2006.
“The PQIP workgroup is a select group of less than a dozen key MDCH staff who handle the nuts and bolts operation of PQIP. Molly Bodenschatz is the only drug representative who has ever attended any of the workgroup meetings, according to the sign-in sheets that I’ve obtained through FOIA.”
Meeting notes include com-ments such as: “Molly is educating people in the field—positive feedbk [feedback]…. Molly will check on how Lilly determines docs specialty… FOIA Request discussion — if anything more is publicized — give Molly info.”
Chavers declined comment on why an Eli Lilly’s account executive attends PQIP meetings, and why no other personnel from her competitors attend. She deferred questions to the state spokesman, T.J. Bucholz, who didn’t respond to several requests.
Hansen acknowledges that CNS has provided an extraordinary service by summarizing the number of Medicaid patients taking psychiatric drugs and high-risk behaviors, but he wonders how much data the company sees, versus the regular taxpaying citizen.
But Chavers said that Bodenschatz is privy to no more data than the public could see.
“She is only in the room when they are discussing classes of drugs, such as antidepressants. She is not there when individual drugs are discussed as they would probably be talking about individual patients and doctors. The state has confirmed that. I can’t stress enough that this is a quality improvement program that has been praised nationwide by advocates, physicians and states.”

Hansen’s other concern is that a $44 million study by the National Institute of Mental Health concluded that older and far cheaper antipsychotics are still useful for treating schizophrenia.
“Drug companies have criticized the study because it lasted for only 18 months, but the companies are shamelessly hypocritical because their own clinical trials generally last just 12 weeks or less,” Hansen says.
It’s highly improbable that Eli Lilly will monitor the success or safety of older anti-psychotics over Zyprexa, the costliest drug of its type on the market, Hansen said.
Hansen appears to be waging this battle on his own in Michigan, but there is growing national concern about Eli Lilly’s unethical marketing practices.
Montana became the seventh state to sue Eli Lilly over allegedly promoting off-label uses of Zyprexa. Other states are considering similar action. But Eli Lilly is safe here, since Michigan is the only state that can’t sue a drug company. It would be doubtful, anyway, since Michigan’s own attorney general is fighting in court to stop Hansen from receiving the reports he seeks.
“Instead of joining my effort to shed light on Michigan’s corrupt Medicaid system, our attorney general is fighting against me. Something is wrong with this picture,” Hansen says.

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