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Report: Big Pharma’s Medicaid rigging costs taxpayers millions

Summary and Analysis…

A remarkable, detailed explanation of the tactics drug companies use to artificially jack up costs of Medicaid to states. Using payoffs to doctors, hidden influence on state boards charged with making drug expenditure decisions and falsely representing themselves as doctor office staff, Big Pharma has infiltrated all aspects of the process with stunning financial results.

  • “Medicaid accounts for more than a quarter of 26 states’ budgets….”
  • “From 2008 through 2016, Medicaid drug costs grew almost 50 percent per patient….”
  • The result — a nearly doubling of Medicaid drug spending to $31 billion.

The article describes multiple instances in which those testifying in front of the state boards responsible for containing costs while providing quality patient care had undisclosed financial ties to Big Pharma. In other cases, members of the board themselves had such ties.

The article describes a nationwide pattern of state board corruption only some of which has been targeted by whistleblower lawsuits or other anti-corruption actions.

One result of the investigation — several doctors resigned positions or abstained from votes on certain drugs. While cleaning up individual problem doctors is helpful, the report makes it clear that systemic change is needed.

This report has everything to do with the current debate swirling around how to address the opioid crisis. The pattern of infiltration and corruption should be understood and taken into account when communities begin to listen to authorities when making decisions about drug company and “independent” doctor-backed Medication-Assisted Treatment (MAT) programs.

Excerpted from NPR

Center for Public Integrity and NPR investigation found drug companies have infiltrated nearly every part of the process that determines how their drugs will be covered by taxpayers: giving free dinners and consulting gigs to many doctors on the obscure committees advising state Medicaid programs; asking speakers who don’t disclose their financial ties with drug companies to testify about their drugs; and paying for state Medicaid officials to attend all-inclusive conferences where they can mingle with drug representatives.

Beyond that, drugmakers use other tactics to get their products paid for by the Medicaid programs: lobbying state lawmakers to achieve their goals or helping doctors fill out extra paperwork to get Medicaid to pay for the costlier drugs as Warner Chilcott did. The result is that Medicaid sometimes spends more than necessary and may pay for medicines inappropriate for patients.

Around the country, drug companies are working to influence state Medicaid drug cost controls to keep their profits flowing. Meanwhile the cost of Medicaid is ballooning, not only because the program expanded in 33 states and the District of Columbia under the Affordable Care Act.

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