“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.
HOW IT WORKS 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?
PUMPED-UP NUMBERS 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.
TARGETING KIDS? 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.
STRINGS ATTACHED 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.
BIG BUCKS 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.
INFLUENCE 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.”
COST EFFECTIVE? 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.
