Today’s technology could have tempered the landslide of opioids into several small West Virginia communities, the executives of top drug distributors tried to tell incensed members of Congress yesterday.
It was quite the scene Tuesday morning at the House Energy and Commerce Oversight subcommittee, where past and current executives of five pharmaceutical companies walked the figurative gauntlet before Democratic and Republican lawmakers. The committee had spent the past year probing the drugmakers' role in pill dumping in West Virginia — the state with the highest rate of opioid overdose deaths.
The hearing room was packed with attorneys, lobbyists and staffers for the pharmaceutical industry and lawyers for counties, towns and cities, many of which are involved in a massive, consolidated case in Cleveland where localities are going after the industry for the wreckage its products have caused in communities across the country.
Lawmakers drilled the executives on key questions, such as whether they fell short of complying with federal regulations to report suspicious orders, whether their products have contributed to the opioid abuse crisis and how they’re ensuring pill dumping doesn’t happen again.
The executives did display some regret. Cardinal Health executive chairman George Barrett said he’s sorry the company didn’t act more quickly to halt the sending of millions of hydrocodone and oxycodone pills to pharmacies in West Virginia.
“With the benefit of hindsight, I wish we had moved faster and asked a different set of questions,” Barrett said. “I am deeply sorry we did not. Today, I am confident we would reach different conclusions about those two pharmacies.” And Joseph Mastandrea, chairman of Miami-Luken’s board, said that he believes his company contributed to the opioid crisis.
But Barrett, along with executives from AmerisourceBergen, McKesson and H.D. Smith said they don’t think their companies contributed to the opioid crisis, my colleagues Katie Zezima and Scott Higham report.
“They argued that their companies do not manufacture or prescribe drugs; they fulfill orders from pharmacies,” Katie and Scott write. “Distributors, they argue, are not responsible for overprescribing medications. The companies also say that opioid painkillers account for a small portion of their overall business.”
The executives also stressed that their companies have taken steps to prevent the diversion of drugs and to help fight the opioid crisis, when pressed by Energy and Commerce Committee Chairman Greg Walden (R-Ore.) and ranking Democrat Frank Pallone (N.J.) to explain how things are different now.
Barrett said his company has implemented algorithms into its distribution system that stops suspicious orders automatically. “I think we would do things very differently today,” Barrett told the panel. “We look at data, and if the data tells us there is an apparent pattern we simply stop.”
“We have learned serious lessons from the past,” said McKesson chief executive John Hammergren. “Our systems today are automated and not subjective.”
Members were armed with loads of data to throw at the executives. Here are a few of the committee’s most shocking findings, which lawmakers referred to repeatedly:
—A single pharmacy in the 1,779-person area of Mount Gay-Shamrock, W.Va. received more than 16.5 million hydrocodone and oxycodone pills between 2006 and 2016. That averages out to 927 pills per person, per year.
—During the same period, distributors sent 20.8 million opioids to the 2,900-person city of Williamson. That’s an average of 717 pills per person, per year.
—Over a two-year period, opioid distributors shipped 9 million pills to Kermit, whose population is 406. That’s more than 11,000 pills per resident each year.
It’s powerful evidence that the distributors — for a varying set of reasons — may not have exercised sufficient oversight of where their products were going. Several of them have paid hefty fines to the Drug Enforcement Administration, as Katie and Scott note.
Cardinal Health was fined $44 million in 2016 to resolve allegations that it failed to report suspicious orders of narcotics and paid a $34 million fine in 2008 to settle similar allegations. McKesson agreed to pay $150 million in fines in January to resolve allegations that it failed to report suspicious orders of narcotics. In 2008, the company paid a $13 million fine for similar allegations.
So, it’s not terribly surprising that things got heated at points at points in the hearing, like when Rep. David McKinley raised his voice. McKinley, a Republican, represents the northern part of West Virginia.
“I am so frustrated for all the people in West Virginia and across this country that you all have not … stepped up and took more responsibility for this,” McKinley said. “The fury inside me right now is bubbling over.”
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AHH: CDC Director Robert Redfield has agreed to take a pay cut from $375,000 to $209,700, putting his compensation more in line with those of previous agency chiefs, The Post's Lena H. Sun reports. Redfield had recently come under fire for enjoying a salary much higher than his predecessors.
“Dr. Redfield did not want his compensation to become a distraction from the important work of the CDC and asked that his salary be reduced,” said Health and Human Services spokeswoman Caitlin Oakley. “Dr. Redfield is being paid in accordance with the formula used to pay the prior three CDC directors. Using that formula, his compensation for this year will be $209,700.”
"The longtime AIDS researcher asked HHS Secretary Alex Azar for his $375,000 salary to be cut after a top Democratic senator and others raised questions," Lena writes. "His initial pay was almost twice what his predecessor earned and more than other past directors...Brenda Fitzgerald, the former Georgia health commissioner who resigned from the CDC in late January because of financial conflicts of interest, served for half a year at an annual salary of $193,700."
OOF: Drugmaker Valeant Pharmaceuticals International is changing its name to Bausch Health Companies, effective in July. Valeant, which has been at the receiving end of negative public scrutiny over high drug prices, is looking to reshape its brand by using the name of its more respected subsidiary, eye care company Bausch Lomb, the New York Times’s Katie Thomas reports.
“The company’s decision to change its name recalled other companies’ efforts to revamp their reputations in the wake of scandal, such as the tobacco maker Philip Morris Co. changing its name to Altria, or ValuJet Airlines’s switch to AirTran,” Katie writes. "Since taking over as chief executive, [Joseph Papa] has sought to rebuild the company’s reputation, replacing much of its top management and vowing to limit annual price increases to less than 10 percent a year. It still had about $25 billion in debt as of the end of 2017."
The rebrand also comes as a former Valeant executive is on trial in federal court in New York on charges that he defrauded the company.
OUCH: Fewer workers in the United States tested positive for prescription painkillers last year, but more tested positive for cocaine, methamphetamine and marijuana. That's according to new data from Quest Diagnostics, one of the largest drug-testing labs in the country, the Wall Street Journal’s Lauren Weber reports.
The overall rate of workers and job applicants testing positive for illicit drugs last year remained steady at 4.2 percent, the same rate as in 2016, while the mix of reasons for positive tests shifted. Positive tests for opiates such as morphine and oxycodone dropped by 17 percent in 2017, perhaps reflecting new crackdowns on illegal or excessive opioid prescriptions.
Meanwhile, positive tests for cocaine, methamphetamine and marijuana have increased. In Nevada for example, where marijuana was legalized last year, positive tests rose 43 percent. “Quest data suggested a continuing surge in methamphetamine use in the Midwest, South and parts of the Northeast,” Lauren writes. “Some states, including Nebraska and Idaho, saw sharp increases in cocaine positives.”
— Remember those extra Obamacare subsidies Congress was trying — sort of — to give back to insurers? They're dead, and now lawmakers are kicking dirt over the grave.
A quick review: The agreement hammered out between Sens. Lamar Alexander and Patty Murray, the top Republican and Democrat on the Health, Education, Labor and Pensions Committee, faltered under partisan disputes this year. Democrats refused to add funding for the subsidies (which reimbursed marketplace insurers for cost-sharing discounts) into spending bills, incensed that Republicans had punched holes in the Affordable Care Act instead of trying to improve the law and then tried to add antiabortion language to the originally bipartisan agreement.
But Alexander and Murray can't seem to let the issue go. In a letter to supporters this week, Alexander accused Democrats of being unwilling to make any modest, temporary changes to the Affordable Care Act and essentially washed his hands of the matter, asserting that he's focusing on unilateral ways the Trump administration can change the health-care law.
“Given Democrats' attitude, I know of nothing that Republicans and Democrats can agree on to stabilize the individual health insurance market,” Alexander wrote.
Murray issued a scathing response, characterizing Democrats as the ones willing to negotiate. “Democrats are not walking away from the table even if Republicans are,” she said. “We want the Republican health care sabotage to stop and we want families’ health care costs to go down — and we are ready to work with Republicans as soon as they decide to join us and put patients and families ahead of partisan politics and special interests.”
(The Health 202 maintains our official position that all this could be resolved if the two senators would just chill out together over a bottle of whiskey from Scottish whiskey bottler Alexander Murray & Company.)
— Sen. Orrin Hatch (R-Utah) has apologized to Sen. John McCain (R-Ariz.) for saying it was “ridiculous” for McCain to request that President Trump not attend his funeral, a remark that drew a swift rebuke from McCain’s daughter Meghan McCain. “I agree with the daughter,” a remorseful Hatch told The Post's Sean Sullivan and Paul Kane yesterday. “I shouldn’t have said anything yesterday. I agree a hundred percent with her.”
Hatch also sent a letter to McCain — who is at home in Arizona battling a serious form of brain cancer — apologizing for his comment and for suggesting that McCain wouldn't return to the Senate, Sean and Paul write.
— Yesterday, the House Veterans Affairs Committee passed a plan 20-2 to give veterans increased freedom to see doctors outside of the VA health system and to fix a budget crisis in its troubled private-sector program. The plan goes toward fulfilling President Trump’s campaign promise to expand private care options for veterans, The Associated Press’s Hope Yen writes.
The committee approved a $51 billion plan including more than $5 billion to avoid a shutdown of the VA's Choice private-sector program, which is set to run out of money as early as the end of the month and could halt care for tens of thousands of patients, Hope reports. “It paves the way for passage of the long-sought bill after previous failed attempts including in March, leading in part to Trump’s firing of former VA Secretary David Shulkin,” she writes. “Nearly 40 organizations, including Veterans of Foreign Wars and the conservative Concerned Veterans for America, support the measure.”
“The plan… would mean that veterans could see private doctors at taxpayer expense when VA medical centers are unable to provide timely treatment or the care is deemed inadequate,” she adds. “Still, it may take years to assess the full impact on veterans who turn to private doctors over government-run VA care, due to uncertainty in how the rules will be interpreted and how VA determines what is ‘quality’ care.”
— A few more good reads from The Post and beyond:
- The House Oversight Subcommittees on Healthcare, Benefits, and on Administrative Rules holds a hearing on “Program Integrity for the Supplemental Nutrition Assistance Program."
- The Kaiser Family Foundation holds a forum on healthcare prices.
- The Heritage Foundation holds an event on mental illness on Friday.
- The Alliance or Health Policy holds an event on state opportunities to address prescription drug costs in Medicaid on Friday.
- Senate Health, Education, Labor and Pensions Committee holds a hearing on “Examining Oversight Reports on the 340B Drug Pricing Program” on May 15.
- The American Enterprise Institute holds an event on “Reshaping the veteran narrative with the Department of Veterans Affairs” on May 15.
- The American Enterprise Institute holds an event on “Fixing health care: Driving value through smart purchasing and policy” on May 16.
What to watch in this year's state primaries:
Stephen Colbert weighs in on the allegations against New York AG Eric Schneiderman: