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Patient Front Groups Loot Medicare Dollars for Big Pharma


The Obama administration is finally addressing the expensive, dangerous and usually unnecessary psychiatric drugs that are footed by taxpayers in federal entitlement programs. It has proposed that insurers may limit Medicare coverage of certain classes of drugs that include Wellbutrin, Paxil and Prozac for depression and Abilify and Seroquel for schizophrenia.

How expensive are these drugs? 100 middle dose pills of the widely marketed Abilify cost as much as $1,644. 100 pills of Geodon are $958, Invega, $1,789, Risperdal, $953, Seroquel, $2,000 and Zyprexa, $1,680, if the brand name drugs are used, which drug company  lobbyists hope. Thanks to their lobbying, insurers have to pay “all or substantially all” of such depression and schizophrenia drug costs because the drugs enjoy “protected status” in the Medicare program. Such protected pills account for as much as 33 percent of total outpatient drug spending under Part D of Medicare, says the New York Times.

Not surprisingly, Big Pharma and its patient front groups are livid that the heisting of US taxpayers dollars could be curtailed. Abilify alone has earned over $4 billion a year! “The proposal undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries,” said Andrew Sperling, a lobbyist at the National Alliance on Mental Illness (NAMI) which is fighting the Obama proposal.

As much as 75 percent of NAMI’s donations come from drug companies says the New York Times and it has been investigated by Congress. Portraying itself as “patients,” NAMI also successfully fights states’ efforts to limit use of the most pricey Medicaid psychiatric drugs, in parallel lobbying. “Some of these medicines routinely top the list of the most expensive drugs that states buy for their poorest patients,” says the Times. NAMI is “hugely influential in many state capitols,” it adds.

The heart of Big Pharma and NAMI lobbying is making sure expensive drugs are on Medicare and Medicaid formularies and that doctors prescribe them first–before and instead of lower priced drugs. The expensive-drugs-first marketing is couched as “patient choice” or another “treatment option” by Pharma lobbyists as if there’s no difference between a $45 prescription and $450 prescription. Antipsychotic drugs work in different ways in the body explains Sperling and “You get much better outcomes when a doctor can work with patients to figure out which medications will work best for them.” Ka-ching.

The problem is newer, more expensive drugs are not necessarily better than older, less expensive drugs and they are often more dangerous. One chilling example is an estimated 15,000 elderly people die in nursing homes a year from inappropriately given antipsychotic medications, according to FDA drug reviewer David Graham, MD.  Pharma is aware of the profiteering and “laughing all the way to the bank,” Graham speculated.

Antipsychotics like Seroquel carry warnings that they cause death in elderly people who have dementia but are nevertheless in wide use in many geriatric, federally-supported facilities. So much for NAMI’s concern for “the sickest, most vulnerable Medicare beneficiaries.”

NAMI is not the only group to play on the public’s heart strings to keep drug revenues flowing. Pharma’s aggressive opioid lobby says patients with legitimate pain will suffer if drugs like Oxycontin, killing 17,000 Americans a year, are regulated. Similarly, if Abilify and Seroquel are regulated within Medicare, someone will suffer–Big Pharma.

Martha Rosenberg is an investigative health reporter. She is the author of  Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).






Martha Rosenberg is an investigative health reporter. She is the author of  Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).

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