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 John Kapoor, the billionaire board
chairman of Lake Forest-based Akorn Pharmaceuticals and founder of Arizona-based
pharmaceutical manufacturer Insys Therapeutics Inc., has been charged by federal
prosecutors with leading a nationwide conspiracy to bribe doctors to prescribe
his company’s opioid painkiller, according to the Chicago Tribune.
This is just the latest trouble for Insys, which settled a lawsuit with the
state of Illinois for $4.45 million in August. Illinois Attorney General Lisa
Madigan sued Insys in 2016, alleging the company deceptively marketed and sold
Subsys, a fentanyl spray advertised on its site as providing relief for
“breakthrough cancer pain,” to doctors for off-label uses, according to Reuters.
 The federal indictment also charges Kapoor and other defendants with insurance
fraud for their efforts to get insurance companies to cover prescriptions for
Subsys for patients who did not have cancer. Other Insys personnel, such as the
firm’s former CEO, five other former executives and at least two sales
representatives have faced charges for using speaker fees and marketing events
to bribe doctors to prescribe Insys’ cancer-pain-relief drug to non-cancer
patients. Boston-based Acting U.S. Attorney William D. Weinrib said federal
officials indicted Kapoor pursuant to “ongoing efforts to attack the opioid
crisis from all angles,” according to the Tribune.
The gravity of the opioid crisis caused President Donald Trump in October to
officially declare it a public health emergency. The Centers for Disease Control
and Prevention, or CDC, notes on its site that in 2014, “almost 2 million
Americans abused or were dependent on prescription opioids.”
Opioid-related risks in Illinois’ workers’ compensation system
The opioid epidemic has taken its toll on Illinoisans, too. Data from the
Illinois Department of Public Health, or DPH, show 2,278 drug-related overdose
deaths occurred in Illinois in 2016, up 44 percent from 2013. Of those drug
overdose deaths, 80 percent were opioid-related, according to DPH data.
Yet despite the dangers of opioid abuse, Illinois lawmakers still have not
addressed a feature of Illinois’ workers’ compensation system that has been
shown to increase the risk that an injured worker will receive an unnecessary
prescription for a potentially dangerous opioid painkiller.
 Rather than requiring injured workers to fill their prescriptions at a pharmacy,
Illinois’ workers’ compensation system allows physicians to dispense drugs
directly to patients – a practice that has been shown to increase workers’
compensation costs, workers’ time off the job and the amount of opioids
prescribed to injured workers.
According to a study by Johns Hopkins University researchers of workers’
compensation claims opened and closed between 2007 and 2012, physician
dispensing in Illinois’ workers’ compensation system resulted in doctors writing
more than three times the number of opioid prescriptions they write when a
pharmacy dispenses the medication. This study also showed that costs increased
dramatically in cases in which physicians dispensed medication rather than
having patients fill prescriptions at a pharmacy.
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In 2011, Illinois lawmakers enacted workers’ compensation reforms to
try to rein in costs, including those due to physician dispensing of
medication. But loopholes remained, and post-reform, the percentage
of workers’ compensation prescription costs attributed to
physician-dispensed drugs actually rose in Illinois, according to a
2017 study by the Workers Compensation Research Institute, or WCRI.
The WCRI study’s authors concluded that the high percentage of
prescription prices in Illinois attributable to physician dispensing
was due to “frequent physician dispensing of higher-priced new drug
products.”
Several of the “new” drug products physicians had begun dispensing
were actually existing drugs formulated by manufacturers with
different strengths and assigned prices that were far higher than
those for existing-strength medications. Among the new-strength
drugs were the opioid painkiller 150 milligram tramadol extended
release and 2.5-325 milligram hydrocodone-acetaminophen (an opioid
painkiller of which Vicodin is a well-known brand).
The WCRI study authors noted these new-strength drugs were seen
almost exclusively in physician-dispensed prescriptions, and not in
prescriptions filled in pharmacies. That suggests motives other than
patient well-being were likely at play in prescribing the new, more
expensive drugs.
Thus, the loopholes in Illinois’ workers’ compensation system
continue to drive up costs while threatening worker safety.
Illinois bill to reform physician dispensing never made it to full
House vote
In February, state Rep. Barbara Wheeler, R-Crystal Lake, filed a
bill to close the loophole in Illinois’ workers’ compensation system
that provides incentives for some doctors to overprescribe certain
medications. House Bill 2892 would deny reimbursement under the
Illinois Workers’ Compensation Act for prescriptions “filled and
dispensed outside of a licensed pharmacy.” The bill makes a narrow
exception for direct dispensing of medication in cases where a
licensed pharmacy is more than 5 miles from the doctor’s office. In
those cases, a doctor will be reimbursed only for a supply of
medication that lasts for the greater of “72 hours from the date of
the injury or 24 hours from the date of first referral to the
medical service provider.” The bill would also allow prescriptions
to be filled outside of a licensed pharmacy in cases in which a
preferred provider program’s agreement with a physician provides for
this.
Reasonable reforms such as Wheeler’s ensure injured workers in need
of pain medication can still have their prescriptions filled at a
licensed pharmacy. Her bill simply protects injured workers by
limiting doctors’ ability to sell those drugs directly within the
workers’ compensation system.
Notwithstanding Illinois’ mounting opioid crisis, high workers’
compensation costs and the risk that physician dispensing can pose
to injured workers – as well as the extra costs this practice
imposes on taxpayers, who pay for workers’ compensation for
government employees – this commonsense reform never made it to a
vote on the House floor.
Federal and state officials have sounded the alarm about opioid
abuse. It’s time Illinois lawmakers address potentially contributing
factors in the workers’ compensation system. Passing HB 2892 would
be a good start.
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