From 2008 to 2016, the amount that state Medicaid programs spend on prescription drugs almost doubled. NPR and the Center for Public Integrity wanted to understand why, so reporters Liz Essley Whyte, Joe Yerardi, and Alison Kodjak interviewed dozens of people and dug through hundreds of pages of data, financial disclosures, and court reports. Following the money and influence led back to the people benefitting the most: drug companies, and the doctors on their payrolls.
Pharmaceutical firms have tremendous incentives to be included on states’ lists: It makes doctors far more likely to prescribe their drug to Medicaid patients and can encourage other insurers to follow suit. To nab spots on the coveted lists, drugmakers often offer the states discounts known as “supplemental rebates,” called supplemental because they come on top of other price concessions required by federal law.
The drug committee meetings where those list decisions are made are a frequent destination for drug company representatives — and those who benefit from their largesse.
At the Texas meeting alone, 12 people advocated for the state’s list to include brand-name antipsychotic drugs, especially the expensive ones. Five of the speakers worked for drug companies. One represented a patient advocacy group that gets significant funding from drugmakers. At least four of the remaining six, including Patel, had ties to drugmakers despite claiming to represent themselves.
Another psychiatrist, Matthew Brams, praised injectable mental health drugs and mentioned that he had researched them in the past. But he did not disclose the more than $181,000 their makers Otsuka and Alkermes PLC paid him to speak about them over the past two years, according to the federal Open Payments database.
Patel, Brams, Otsuka and Alkermes did not respond to requests for comment.