Posts Tagged ‘McKesson’

The Opioid Lawsuits

 

 

 

 

Around twenty-seven hundred plaintiffs, composed of states, counties, and cities, have joined the lawsuit against drug manufacturers, distributors, and some pharmacy chains. Their lawsuit alleges these companies acted illegally and contributed to the opioid epidemic. Last month, some of the organizations being sued offered a common-sense solution that would benefit people with opioid use disorder. [1]

The actual lawsuit is similar to lawsuits against Purdue Pharma, manufacturer of OxyContin. Purdue filed for bankruptcy in September of 2019, offering a settlement to twenty-five hundred or so plaintiffs which included states, cities, counties, and tribes. The proposed settlement, announced in September of 2019, totaled around $12 billion, with $3 billion coming from the Sackler family directly.

Proponents of the Purdue Pharma settlements say it avoids wasting time and money on protracted litigation, which usually provides maximum benefits to the the lawyers on each side, rather than the plaintiffs. A quick settlement also – in theory – makes money available more quickly to people suffering from the opioid epidemic.

On the other side, some lawyers point out this money won’t be enough to cover the damage caused by the opioid epidemic. Some doubt that those who need it will receive much of the $12 billion. They also object to the fraction paid by the Sackler family, owners of Purdue Pharma, made rich by the sales of OxyContin over the years. The settlement, as it stands now, has no provision for admission of guilt by the pharmaceutical company, which does not sit well with some of the plaintiffs.

Both sides make good points. However, I don’t think there’s a settlement large enough to cover all the damages caused by the opioid epidemic, so that’s not a realistic demand. Deciding who benefits from a settlement needs to be determined by representatives of the plaintiffs, not the defendants.

But now last month, a group of pharmaceutical companies, drug distributors, and pharmacy chains proposed a settlement of the lawsuit being brought by states, counties, and cities across the nation. Teva Pharmaceutical, Johnson& Johnson, McKesson, Amerisource Bergen, and Cardinal Health. and announced recently a proposed settlement amounting to $23 billion including some interesting provisions.

Teva, an Israeli company, agreed to provide their part of the settlement of the lawsuit in the form of generic buprenorphine/naloxone tablets to treat opioid use disorder. They would also pay $250 million over ten years. They claim to be capable of providing all the treatment medication needed by patients in the U.S., after a few years to ramp up production.

The drug distributors agreed to distribute this medication for free, which would allow patients access the treatment medication for next to nothing except a small dispensing fee from the pharmacy, which might also be waived by the lawsuit agreement.

The common sense of this settlement is astounding. This settlement would directly benefit the people who need it most. That’s always a challenge in this sort of lawsuit; even when money is won, distribution of the money can be contentious. I’m sure we all could imagine ways the money could be mis-managed and end up in pockets of people who haven’t been extremely affected by the opioid epidemic. But the people who developed opioid use disorder – they deserve help accessing treatment.

Medication-assisted treatment is the gold standard of treatment for opioid use disorder, so this settlement idea is based in good science and supported by tons of literature. Besides the reduction in overdose death seen in treatment with methadone and/or buprenorphine, medication to treat opioid use disorder is also associated with better physical health, lower rates of crime, lower suicide rates, and higher employment rates.

This settlement makes sure an evidence-based treatment gets funded, instead of over-used treatments that are outdated and ineffective, such as detoxification episodes. The relapse rates for patients with opioid use disorder are greater than 90% with detoxification, yet we see patients cycle in and out of detox, over and over. Detox alone also increases the risk of death. After patients leave detox, tolerance for opioids is reduced, creating a dangerous risk for overdose death when the relapse does happen. Can you think of any other treatment in the field of medicine that increases the risk of death, yet remains standard practice in many communities? If you did a procedure or prescribed a medication that increased the risk of death to people with diabetes, malpractice lawsuits would sprout all over the place.

Not so with the treatment of opioid use disorder.

Teva has made a common sense offer that allows them to do what they do best – make pharmaceuticals – in order to help people with opioid use disorder. The distributors would do what they do best – distribute – in order to help people with opioid use disorder.

Rarely in civil litigation do we see such meaningful settlements with the potential to help the people who suffer most from corporate wrongdoing. This could be a great example of corporate amends…when you break something, do your best to fix it.

Also, this solution would allow Teva and other pharmaceutical companies and distributors to stay in business. Demanding an unreasonable payday might push these big companies to declare bankruptcy and go out of business. These companies provide employment for people and provide services to our nation. We need them to stay in business, while still acknowledging the harm they did and taking financial responsibility for helping clean up the mess

Only the combination product would be donated. This means patients who are prescribed the monoproduct purely for economic reasons could be switched to the less-divertible combination product. That would be wonderful for facilities like the opioid treatment program where I work. Right now, our OTP buys monoproduct because it’s the cheapest form of buprenorphine on the market. Since we do directly observed dosing, diversion is less of an issue, though still an issue. With this sort of agreement, we would switch to the combination product, since not only would the combo product be less expensive, but it would be free.

What would this mean for opioid treatment programs? I’m not sure, but if OTPs could obtain buprenorphine/naloxone treatment medication for free, there should be a corresponding drop in treatment fees. Perhaps instead of a patient having to pay $15 per day for buprenorphine 16mg, they might pay less than $8 per day. I don’t know how much our OTPs pay per pill now, so I’m estimating. I do know that a bigger chunk of what OTP patients pay each day goes to medication costs with buprenorphine, compared to patients on methadone.

For patients who dose at OTPs who are now covered by the recent SORs and CURES grants, that’s money that could be saved, and spread farther to cover more patients. It’s a direct benefit to the taxpayers.

Some patients now on methadone for the treatment of opioid use disorder would switch to buprenorphine/naloxone if it were cheaper. At the opioid treatment program, some patients start methadone because it costs about three dollars per day less than buprenorphine. Again, it doesn’t sound like much of a cost savings, but $3 per day adds up over time. With this proposal, choosing buprenorphine/naloxone would be the cheapest (and often safest) option for treatment.

Of course, there are nay-sayers regarding the settlement. Already, I found online articles complaining that the $23 billion was based on Teva’s retail price for the medication and not their cost of producing the medication.

I suspect lawyers representing plaintiffs won’t be happy about the settlement. If they take cases like this on contingency fees, they would be happier with a big settlement where they take their percentage off the top. This solution wouldn’t benefit lawyers as much as the people who have opioid use disorder, and their families.

I’m proud that my home state of North Carolina is one of four states supporting this innovative settlement proposition along with Tennessee, Pennsylvania, and Texas. The other states, not to mention numerous counties and cities, have not – yet – agreed to the proposed settlement.

There are sure to be talks about pros and cons of the settlement, but I’m hoping this proposed settlement moves forward, because I love a common-sense solution.

  1. https://www.biopharmadive.com/news/teva-opioid-settlement-offer-23-billion-suboxone/565493/