State may give preference to drug maker it’s suing

The Ohio Department of Medicaid is considering giving preferred treatment to a drug company that the state is suing.

Ohio Medicaid Director Barbara Sears will decide next month whether to accept the recommendation of a state consultant to exclusively name Suboxone a preferred drug despite requests from doctors for other options to treat patients with opioid addiction. Sears could opt instead to go with the recommendation made by an advisory board last week to keep another such drug, Zubsolv, on the preferred list and add another, Bunavail.

Being on the preferred list is a boon to a drug maker because Medicaid and the managed-care plans it administers will only pay for other drugs if doctors show their patients meet certain conditions. And critics say the recommendation by Change Healthcare, Medicaid’s pharmacy benefits administrator, to make tSuboxone the only preferred drug in its class is highly problematic for a few reasons.

One is that a back market for Suboxone — which, like the other drugs, contains the opioid buprenorphine — is cropping up on Ohio’s streets and prisons. Critics say the “film strips” on which it comes make it easy to smuggle and to cut into smaller doses. It can be concealed under stamps, in books or in the hems of clothing, they say.

“We have heard concerns from multiple agencies about that,” said Dan Tierney, spokesman for Ohio Attorney General Mike DeWine.

Burt Dhira, who operates two recovery centers in central Ohio, said drugs other than Suboxone are much harder to convert into cash on the streets.

“We need every medication,” he said, explaining that it’s crucial to be able to offer an alternative to patients who ask for Suboxone instead of turning them out to seek illicit drugs.

Another potential problem with giving Suboxone preferred treatment has to do with those film strips that critics say make the drug so easy to smuggle. Last year, DeWine joined 39 other

state attorneys general in a lawsuit accusing Suboxone manufacturer Indivior of an anti-competitive practice known as “product hopping” — using patent law not to improve a product, but to avoid competition.

Suboxone had been marketed as a tablet that was placed beneath the tongue and dissolved. But in 2007, two years before its patent was to expire, Suboxone’s maker filed an application with the U.S. Food and Drug Administration to deliver the medication in a new way — on a PharmFilm strip to be placed beneath the tongue, the attorneys general complaint says.

The following year, PharmFilm maker MonoSol applied for a patent for its film, which it pitched to customers such as Indivior as “a patent-protected delivery technology (that) can be an ideal strategy for extending the life of a brand as generic incursion approaches,” the lawsuit quotes MonoSol as promising.

Indivior and MonoSol officials couldn’t immediately be reached to comment.

The U.S. District Court for Eastern Pennsylvania last month threw out Indivior’s motion to dismiss the case, so Ohio continues to do business with a company the state’s top cop has accused of overcharging taxpayers.

Despite its problems, Suboxone is an important tool in treating addiction, said Shawn Ryan, president and chief medical officer of BrightView Health, a chain of clinics in Cincinnati. But, he said, so are Zubsolv and Bunavail.

So why did the Ohio Department of Medicaid’s pharmacy benefits administrator recommend making Suboxone the only preferred drug in it class?

The administrator, Change Healthcare, referred questions to the Department of Medicaid.

The company “makes recommendations to the states that enable them to make the best use of taxpayers’ money,” Department of Medicaid spokeswoman Brittany Warner said in an email. She added that Change Healthcare is not owned or affiliated with any drug company, nor does it get a share of any rebates drug makers might offer the state.

At Wednesday’s advisory committee hearing, concerned treatment providers said they had heard that Change Healthcare proposed cutting the preferred drug list to Suboxone after its maker threatened to reduce its rebate to the state, effectively raising its prices. Asked about that, Warner said rebate agreements “are confidential information and not subject to public records law.”