By CRAIG MAUGER
Michigan Campaign Finance Network
LANSING (Sept. 5, 2019) — Most of Michigan’s 83 counties have sued Cardinal Health and other drug distributors over their alleged role in the opioid epidemic.
The Michigan Office of Attorney General joined a 41-state investigation just two years ago into the practices of Cardinal Health and seven other drug companies.
But state lawmakers have proved more welcoming. Cardinal Health registered to lobby in Michigan this year, and a bill backed by the company has gained the support of key health care interest groups and has been quietly advancing within the Legislature.
Senate Bill 340 would open Michigan to so-called remote pharmacies, allowing pharmacists in one pharmacy to help fill prescriptions in another pharmacy through a video connection. The idea is to increase access to pharmacies in rural areas, said the bill’s sponsor, Sen. Curtis VanderWall, a Republican from Ludington.
“In my district we have people who are unserved and have no way to get to a pharmacist or visit a pharmacist without someone driving them in to get there,” VanderWall said. “It targets rural Michigan where there are holes in service and access to care.”
But opponents argue an influx of remote pharmacies could increase illegal prescription drug use. One group of local pharmacists alleged the proposal could “fuel” the state’s opioid epidemic — something supporters deny.
VanderWall did not respond to repeated interview requests over several weeks. But he eventually spoke to MCFN while leaving a committee meeting on Wednesday — the same day the Senate took a procedural step that could set up a vote from the full Senate as early as today. UPDATE: The Senate approved the bill in a 32-6 vote this morning, Sept. 5. The bill now goes to the House for consideration.
VanderWall said he wasn’t aware of concerns opponents of the bill have about at least 60 Michigan counties naming Cardinal Health along with other drug distributors and manufacturers in opioid-related lawsuits. Mason County, part of VanderWall’s Senate district, filed its suit in January 2018, according to court documents. Like others, Mason County’s suit said Cardinal Health was one of three wholesale distributors that accounted “for almost 90 percent of the entire wholesale drug market.”
“The failure of all distributor defendants to effectively monitor and report suspicious orders of prescription opioids and to implement measures to prevent the filling of improper prescriptions greatly contributed to the vast increase in opioid overuse and addiction,” the lawsuit alleged.
Outside Michigan, hundreds of local governments and some states have filed similar suits.
The suits allege that the local governments bear the brunt of costs from the opioid crisis, including increased jail expenditures, law enforcement and emergency service costs and judicial proceedings. State figures show 1,941 people died in opioid-related deaths in Michigan in 2017.
“This is the first time I’ve heard that,” VanderWall said when asked about the lawsuits against Cardinal Health on Wednesday.
Cardinal Health is “vigorously defending” itself, according to a 2019 report from the Columbus Dispatch.
“Cardinal Health cares deeply about the opioid epidemic and takes seriously our commitment, in cooperation with everyone else in the prescription drug supply chain — state and federal government regulators, pharmaceutical manufacturers, doctors and other healthcare providers, insurers and pharmacies — to find and support solutions to this national challenge,” the company told MCFN in a statement.
Asked if Cardinal Health had a say in writing Senate Bill 340, VanderWall said no. However, a spokesperson for Cardinal Health said in a statement that it “worked with Senator VanderWall … to develop the legislation based on the unique needs of the state, success in other states and feedback from pharmacists, health plans, hospitals and other stakeholders.”
Cardinal Health, which wasn’t registered to lobby in Michigan until Feb. 1, 2019, reported spending $9,300 lobbying state government through the end of July.
VanderWall introduced the bill on May 22. The Senate Health Policy and Human Services Committee took testimony a day later. An employee of Cardinal Health was the first person to speak on the bill after VanderWall.
Later, the Senate Health Policy and Human Services Committee unanimously voted to advance the bill to the full Senate. The Michigan Association of Health Plans and the Michigan Health & Hospital Association — two of the largest health care interest groups in Lansing — have supported the bill.
The Michigan Health & Hospital Association had the fifth largest political action committee (PAC) in Michigan over the first seven months of 2019. The Michigan Association of Health Plans had the 31st and 87th largest PACs. The three PACs contributed $103,475 to the fundraising committees of the 10 members of the Senate Health Policy and Human Services Committee, according to disclosures.
Jeff Romback, deputy director of policy and planning for the Michigan Association of Health Plans, said the organization supports to the bill “to improve access to pharmacy-related services for Michiganders who live in rural areas.”
Asked if the Michigan Health & Hospital Association is concerned the bill could worsen the opioid crisis, spokesperson Ruthanne Sudderth said no. Technicians in the remote pharmacies would be under surveillance by pharmacists and remote pharmacies would face limits for how many prescriptions they could fill each day, she noted.
The Michigan Pharmacists Association took a neutral position at the most recent committee hearing, but some individual pharmacists don’t like the bill. MCFN spoke with three pharmacists for this report. Two requested anonymity because of fear of retaliation from companies that may be considering starting remote pharmacies. One source said “every pharmacist” she knows is concerned about the bill.
The Macomb County Pharmacists Association said the bill has “the potential to fuel the opioid crisis in Michigan” by diminishing pharmacists’ direct oversight and allowing more drugs to be handed out improperly, according to an online statement.
Nancy Lewis, who's been a pharmacist for 40 years in Michigan and Delaware, said the bill “didn’t come from the pharmacy profession.” Lewis said people who want to abuse prescription drugs go from pharmacy to pharmacy to determine where they can most easily obtain drugs. The bill would give more responsibility to pharmacy technicians who would be physically present in remote pharmacies, Lewis said. Those technicians are paid less, have less training than pharmacists and are more likely to make mistakes, she argued.
Earlier this year, Brian Sapita, governmental affairs manager for the Michigan Pharmacists Association, said his organization’s board was split on the proposal. However, Sapita rejected the idea that remote pharmacies would increase prescription drug abuse. Sapita argued that a pharmacist would retain prescription oversight through a video link. Plus, he said pharmacy technicians are trained to identify improper prescriptions.
Under the bill, a pharmacist could simultaneously oversee three pharmacies, including two remote pharmacies. The bill would require a video connection and public notification when a pharmacy is a remote pharmacy. The bill would also require pharmacists to review prescriptions.
Remote pharmacies could not stand within 10 miles of another pharmacy unless a hospital or other health facility house the remote pharmacy, according to the proposal. However, the state could grant exceptions.
The proposal bans remote pharmacies from dispensing more than 225 prescriptions per day. One pharmacist who declined to be name said he currently fills about 300 prescriptions daily and he didn’t know “how on earth” he could check 450 additional remote prescriptions.
“I cannot believe it,” another pharmacist said of that piece of the bill. “I can’t even fathom it.”