The Origin of the Opioid Crisis Is Even More Troubling Than We Thought

The opioid crisis, which made big noise in the 2016 campaign but which has been somewhat drowned out subsequently by all the shouting about how shoeless refugees are somehow carrying carloads of fentanyl across our southern border, nonetheless remains a classic cautionary tale of the human cost of corporate corruption as well as the human cost of our for-profit medical system. And there seem to be aspects of it yet unexplored. From The New York Times:

Why hadn’t the middlemen, known as pharmacy benefit managers, acted sooner to address a crisis that had been building for decades? One reason, a New York Times investigation found: Drugmakers had been paying them not to. For years, the benefit managers, or P.B.M.s, took payments from opioid manufacturers, including Purdue Pharma, in return for not restricting the flow of pills. As tens of thousands of Americans overdosed and died from prescription painkillers, the middlemen collected billions of dollars in payments.

The P.B.M.s are hired by insurers and employers to control their drug costs by negotiating discounts with pharmaceutical manufacturers. But a Times investigation this year found that they often pursue their own financial interests in ways that increase costs for patients, employers and government programs, while driving independent pharmacies out of business. Regulators have accused the largest P.B.M.s of anti-competitive practices. The middlemen’s dealings with opioid makers reveal a lesser-known consequence of this pay-to-play system: Seemingly everything—including measures meant to protect patients and curtail abuse—can be up for negotiation.

Everything can be up for negotiation.

Everything.

The drug lists, known as formularies, frequently include restrictions meant to save money by steering patients to cheaper drugs. But for some drugs, such as opioids, restrictions can serve a medical purpose—minimizing the risk of overdose and addiction and limiting the number of pills that could be diverted to the illicit market. Yet time and again, documents show, the P.B.M.s bargained away safeguards in exchange for rebates.

Round up the usual suspects.

Purdue’s strategy to ensure broad access to its blockbuster painkiller OxyContin was explicit: “Offer rebates to remove payer restriction,” according to an internal presentation. The company didn’t want doctors to have to provide additional justification for prescribing a powerful narcotic, and it didn’t want strict limits on the number of pills that could be dispensed. The approach worked. Purdue repeatedly boasted in internal reports that prescribers and patients faced few or no restrictions on access to the drug. What could have been a backstop against over-prescribing instead became a sales tool, records show. After striking deals with P.B.M.s, drugmakers touted the favorable coverage—no second-guessing or paperwork requirements from insurers—as part of an effort to get doctors to write more prescriptions.

Human misery is also a for-profit industry.