美国国家公共电台 NPR Investigation: Patients' Drug Options Under Medicaid Heavily Influenced By Drugmakers

 

NOEL KING, HOST:

We have a story now about something called the preferred drug list. It's a powerful tool that states use to try to control spending on prescription¹ drugs in their Medicaid programs. Now, the Center for Public Integrity and NPR conducted an investigation² and found that these lists have become targets for intense lobbying and influence-peddling. We've found that across the country, 3 out of every 5 doctors who serve on the committees that decide which drugs make the preferred list get money or perks³ from drug makers⁴. NPR's Alison Kodjak reports that sometimes those payments add up to hundreds of thousands of dollars.

ALISON KODJAK, BYLINE⁵: When Lisa, who is a drug company sales rep, went to work as an informant for the FBI, they gave her the code name Pampers⁶.

LISA: I was actually about eight months pregnant at the time, so it was quite the experience.

KODJAK: She was working for a drug company that, like many others, uses money, meals and travel to convince doctors to prescribe their medications.

LISA: You just go in there, and you buy the doctor a lobster⁷ dinner. And you fly him out to Tokyo for a conference for a week, and he takes his family.

KODJAK: She says getting doctors to prescribe the drug she was selling was only the first step. The second step was to make sure that insurance companies and the government programs Medicare and Medicaid would pay. And that's where her company got into trouble.

LISA: We were very brazen⁸. And the company took it to the extreme.

KODJAK: Extreme to the point where a sales rep went into patient files and filled out the forms to make sure the company's expensive drugs got paid for.

LISA: They were taking the burden off the physician and taking the burden off the office staff.

KODJAK: Lisa asked that we not use her full name because she worries that news she earned a large legal settlement would create problems for her family. She wore a wire for the FBI and became a whistleblower against her former employer, Warner Chilcott. And she recorded company executives instructing their sales reps how to unlawfully complete those forms. Drug companies filling out those forms is particularly troubling to Medicaid, the health care program for the poor and disabled, because those forms are one of the only tool the program has to control drug costs.

CATHY TRAUGOTT: The amount of money spent on drugs is going up significantly year to year.

KODJAK: That's Cathy Traugott, who runs Colorado's Medicaid pharmacy⁹ program. Medicaid's run by the states, and by law it has to cover every drug that's approved by the FDA.

TRAUGOTT: We can't say no. We have to cover them. So we have to figure out a way to still balance our budget year to year knowing that these costs are consistently going up.

KODJAK: The only tool states have to control those costs is the preferred drug list. Companies will offer states big discounts to get on the list. And if doctors want to prescribe something that's not on the list, they have to fill out time-consuming paperwork to get Medicaid to pay. The investigation by the Center for Public Integrity and NPR shows that around the country, these preferred drug lists are the targets of high-pressure lobbying, and the whole system is mired¹⁰ in financial conflicts of interest. Companies, through sales reps like Lisa, woo doctors with money and perks to get them not only to prescribe the drugs but also to help them get their drugs on the list. And if they don't make the list, many companies move to the next step - filling out patient forms to convince Medicaid to pay for the drugs anyway.

ROBERT HOGUE: We're going to begin. I'm going to call the meeting to order.

KODJAK: Take this meeting of Texas's Drug Utilization¹¹ Review Board.

HOGUE: The next topic is the antipsychotics.

KODJAK: The committee's chairman, Dr. Robert Hogue, starts things off with drugs that treat schizophrenia and severe depression. Millions of dollars are in play.

HOGUE: OK. And we have a hundred speakers.

(LAUGHTER)

HOGUE: Don't be shy. Ladies first. Somebody on the front row, come on.

KODJAK: Twelve people line up to speak. Five worked for drug companies, but many of the others have more subtle financial ties to the pharmaceutical¹² industry. Like Matthew Brams, he's a private practice psychiatrist¹³ who tells the committee he's done research on antipsychotic drugs.

MATTHEW BRAMS: Long-acting injectables, I believe, are superior to orals in many ways.

KODJAK: Brams praises two medications by name, but he doesn't mention that the companies that make them paid him more than $180,000 in speaking fees over the previous two years, according to the government's Open Payments database. Taking such payments is not illegal, but it can have a big impact on doctors' behavior, says Ameet Sarpatwari, a professor at Harvard Medical School who studies the economics of pharmaceuticals¹⁴.

AMEET SARPATWARI: There's been a wealth of studies showing an association between financial conflicts of interest and preferential prescribing practices. And that can be for as little as a $5 lunch.

KODJAK: And it's not just the people testifying who have financial relationships with drug companies. Eight of the doctors on Texas's drug list committee have gotten compensation according to our investigation. And across the country, 3 of every 5 doctors who vote on preferred drug lists get perks from drug companies. Some benefits are small, a dinner or lunch, but sometimes they're consulting jobs worth hundreds of thousands of dollars. None of it is illegal.

SARPATWARI: It is hard to conceive of any situation where, if a pharmaceutical company did not believe that these payments were somehow influencing prescribing, that they would not be making them.

KODJAK: Our investigation shows that the person who gets the most money is Dr. Mohamed Ramadan, who sits on Arizona's committee. He received more than $700,000 in consulting fees, meals and tripped over four and a half years, mostly from two companies that make medications to treat schizophrenia. We spoke¹⁵ to him over the phone from his clinic that sits in the middle of the desert on the border of Arizona, Nevada and California.

MOHAMED RAMADAN: I work with multiple companies, and I do research too. So I keep myself very objective.

KODJAK: He says his work with the companies keeps him up to date on the latest developments in his field. And he says he doesn't see any conflict of interest.

RAMADAN: My thought is that healthy interaction with pharmaceutical companies is important.

KODJAK: But according to whistleblower Lisa, the money can be very effective.

LISA: What the managers within the company would tell us is if they feel indebted to you, if they feel a relationship with you, they're more likely to write your product.

KODJAK: In 2015, Lisa's company, Warner Chilcott, which by then had been purchased by a competitor, pleaded guilty to health care fraud. But our investigation finds several whistleblower lawsuits¹⁶ that allege¹⁷ that drug companies or their subcontractors still routinely help doctors fill out paperwork to get their medications covered. And in the end, all that effort can undermine one of the few tools states have to keep their drug costs down.

Alison Kodjak, NPR News.

1 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

2 investigation   

n.调查，调查研究

参考例句：

• In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
• He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。

3 perks   

额外津贴，附带福利，外快( perk的名词复数 )

参考例句：

• Perks offered by the firm include a car and free health insurance. 公司给予的额外待遇包括一辆汽车和免费健康保险。
• Are there any perks that go with your job? 你的工作有什么津贴吗？

4 makers   

n.制造者，制造商（maker的复数形式）

参考例句：

• The makers of the product assured us that there had been no sacrifice of quality. 这一产品的制造商向我们保证说他们没有牺牲质量。
• The makers are about to launch out a new product. 制造商们马上要生产一种新产品。 来自《简明英汉词典》

5 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

6 pampers   

v.纵容，宠，娇养( pamper的第三人称单数 )

参考例句：

• The biggest is Pampers nappies, which collected more than $7 billion last year. 最大的是帮宝适(Pampers)纸尿裤，去年收获超过70亿美元。 来自互联网
• She pampers her own spoiled children and brings Jane up as little better than a servant. 她对她那些被宠坏了的孩子娇生惯养，但对简则有如对待佣仆。 来自辞典例句

7 lobster   

n.龙虾，龙虾肉

参考例句：

• The lobster is a shellfish.龙虾是水生贝壳动物。
• I like lobster but it does not like me.我喜欢吃龙虾，但它不适宜于我的健康。

8 brazen   

adj.厚脸皮的，无耻的，坚硬的

参考例句：

• The brazen woman laughed loudly at the judge who sentenced her.那无耻的女子冲着给她判刑的法官高声大笑。
• Some people prefer to brazen a thing out rather than admit defeat.有的人不愿承认失败，而是宁肯厚着脸皮干下去。

9 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

10 mired   

abbr.microreciprocal degree 迈尔德（色温单位）v.深陷( mire的过去式和过去分词 )

参考例句：

• The country was mired in recession. 这个国家陷入了经济衰退的困境。
• The most brilliant leadership can be mired in detail. 最有才干的领导也会陷于拘泥琐事的困境中。 来自《现代汉英综合大词典》

11 utilization   

n.利用，效用

参考例句：

• Computer has found an increasingly wide utilization in all fields.电子计算机已越来越广泛地在各个领域得到应用。
• Modern forms of agricultural utilization,have completely refuted this assumption.现代农业利用形式，完全驳倒了这种想象。

12 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

13 psychiatrist   

n.精神病专家；精神病医师

参考例句：

• He went to a psychiatrist about his compulsive gambling.他去看精神科医生治疗不能自拔的赌瘾。
• The psychiatrist corrected him gently.精神病医师彬彬有礼地纠正他。

14 pharmaceuticals   

n.医药品；药物( pharmaceutical的名词复数 )

参考例句：

• the development of new pharmaceuticals 新药的开发
• The companies are pouring trillions of yen into biotechnology research,especially for pharmaceuticals and new seeds. 这些公司将大量资金投入生物工艺学研究，尤其是药品和新种子方面。 来自《简明英汉词典》

15 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

16 lawsuits   

n.诉讼( lawsuit的名词复数 )

参考例句：

• Lawsuits involving property rights and farming and grazing rights increased markedly. 涉及财产权，耕作与放牧权的诉讼案件显著地增加。 来自辞典例句
• I've lost and won more lawsuits than any man in England. 全英国的人算我官司打得最多，赢的也多，输的也多。 来自辞典例句

17 allege   

vt.宣称，申述，主张，断言

参考例句：

• The newspaper reporters allege that the man was murdered but they have given no proof.新闻记者们宣称这个男人是被谋杀的，但他们没提出证据。
• Students occasionally allege illness as the reason for absence.学生时不时会称病缺课。