‘You can’t put a price tag on anybody’s life’
Two years after the overdose that killed her 21-year-old son, Terri Bartlett traveled to Illinois’ state capital to champion an unlikely cause: revamped painkillers.
Bartlett’s son Michael became hooked on Vicodin and later graduated to heroin. In emotional testimony last year, she urged lawmakers to support a bill that would prioritize the new harder-to-crush pills, saying she believed her son would still be alive if abuse-deterrent formulations had been on the market then.
“You can’t put a price tag on anybody’s life,” she said.
Bartlett didn’t know then that she had been recruited into a wide-ranging lobbying campaign. A public relations firm hired by OxyContin-maker Purdue had helped recruit her to support the bill, along with local sheriffs and fire chiefs.
Her words, and similar testimony from parents of drug abusers elsewhere, reflect a tactic used by the drugmakers across the country. For instance, Purdue paid nearly $95,000 for similar lobbying efforts in New York, state records show.
And the industry’s fingerprints are easy to spot in other areas. Of more than 100 bills dealing with the drugs introduced in 35 states in 2015 and 2016, at least 49 featured nearly identical language requiring insurers to cover abuse-deterrent drugs, according to an analysis of data from Quorum, a legislative tracking service. Several of the bill sponsors said they received the wording from pharmaceutical lobbyists.
Since 2012, at least 21 bills related to the drugs have become law, including five that require insurers to pay for the more expensive drugs in Maine, Maryland, Massachusetts, Florida and West Virginia.
Wins in such states will give drugmakers momentum to successfully push for copycat laws elsewhere, noted Paul Kelly, a federal lobbyist who has worked on multistate lobbying campaigns for drugstores and major retailers.
“It’s like a foot in the door,” he said.
Drugmakers have found fierce opposition to their ADF legislation from insurers and employers who would be on the hook for the far pricier opioid variations.
The Illinois bill — and the 48 strikingly similar measures in other states — would require insurers to cover the drugs in the same way as other opioids, which the insurance companies argue would allow drugmakers to charge whatever they want for them.
“That is not the best use of our medical care resources,” Vernon Rowen, vice president of state government affairs for the insurance company Aetna, told Illinois lawmakers after Bartlett testified. “It totally eliminates our ability to negotiate discounts with manufacturers.”
New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie both vetoed such insurance mandates in the past year, citing the high costs and lack of evidence that the drugs help.
Federal health officials also have pushed back against requirements to cover the drugs, citing the “staggering” costs. For example, a 30-day supply of Pfizer’s abuse-deterrent Embeda, a combination drug containing morphine, costs $268, while a 30-day supply of a generic morphine costs roughly $38, according to data compiled by Truven Health Analytics, a company that tracks drug prices set by manufacturers.
The Department of Veterans Affairs’ Dr. Bernie Good estimated that converting the 8.8 million patient system exclusively to the new reformulations would increase opioid spending more than tenfold, to over $1.6 billion annually. Good, who co-directs the VA’s program for medication safety, said the vast majority of veterans are not at risk for snorting or injecting their medications.
“Would the excess money to pay for abuse-deterrent products — mostly to pay for it in cases where it wouldn’t be necessary — be better spent for drug treatment centers?” he asked at a recent federal meeting on the drugs.
Federal estimates say at least 2.2 million Americans are addicted to prescription opioids or heroin, yet only one in five actually receives treatment, according to a Surgeon General’s report published last month. That’s despite some $35 billion already spent annually on substance abuse programs by private and public health providers.
State lawmakers who support the abuse-deterrent bills often defend them as an important piece of solving the opioid puzzle, preventing more costly overdoses and hospitalizations.
And Fred Brason, executive director of Project Lazarus, a North Carolina-based group that promotes anti-addiction policies in several states, called the focus on the drugs’ cost too narrow.
“You’re already spending that money at the back end,” he said. “You’re spending it at the emergency department.” He also noted the costs of addiction treatment.
When critics raise alarms about higher costs and limited evidence, drugmakers can rely on groups they support financially to argue their side, including the National Association of Drug Diversion Investigators, the Academy of Integrative Pain Management and the Partnership for Drug-Free Kids. Representatives from those groups have testified in favor of abuse-deterrent legislation in at least seven states.
NADDI president Charlie Cichon acknowledged his group receives funds from several ADF-makers, but said it views the drugs as a proven part of the solution to the opioid crisis. “We’re not testifying for Purdue Pharma’s product or Endo’s product,” he said.
And Bob Twillman, executive director of the Academy, said, “Increased use of abuse-deterrent opioids makes it more likely that those patients who need opiates to treat their pain will be able to get them.”
The Partnership for Drug-Free Kids did not respond to multiple requests for comment.
Physicians with financial ties to drugmakers play similar roles. Dr. Gareth Shemesh, a pain specialist, testified in support of a Colorado bill last year brought to the sponsoring legislator by Pfizer. Shemesh had received more than $13,500 from Pfizer that year in speaking fees, travel and meals, and more than $5,000 from Purdue the year before. He did not respond to calls for comment, but Pfizer said he was not paid to testify and did not speak on behalf of any specific product.
Purdue and Pfizer also have ramped up contributions to the Republican and Democratic attorneys general associations, which raise unlimited funds to help elect AGs across the country. In 2015 and 2016, they gave a total of $950,000 — more than in the previous four years combined.
To date, 51 attorneys general from U.S. states and territories have signed at least one of two National Association of Attorneys General letters to the FDA, urging the agency to favor abuse-deterrent drugs.
The pro-ADF playbook even includes a bit of political theater. In at least seven states, lawmakers or advocates have pounded the reformulated pills with hammers to demonstrate how difficult they are to smash.
In Illinois, it was Democratic Rep. Sara Feigenholtz wielding the hammer on the same committee that heard Terri Bartlett’s testimony. The main sponsor of the bill prioritizing ADFs, Feigenholtz ranked second-highest among legislative recipients of money from Pfizer since the start of 2010, according to an analysis of data from the National Institute on Money in State Politics. The $6,200 she received during that period was more than she had received in the 14 previous years combined. Her bill passed the committee but later stalled in the Legislature and remains pending.
She did not return multiple requests for comment. Pfizer said its contributions to Feigenholtz go back 20 years and it would be “inaccurate and misleading” to suggest a tie to any one piece of legislation.
Bartlett said she doesn’t mind that Purdue was ultimately responsible for her invitation to testify, even though she didn’t know that at the time. She still supports the bill.
“I want to believe that in every pharmaceutical company there still remains some sort of humanity,” she said. “Saving life is expensive.”