In Risperdal Kickback Case, One Nursing Home Patient Received 67 Different Drugs

Last Updated Nov 5, 2009 3:28 PM EST

The scariest wrinkle in the Omnicare kickback case is just how vulnerable old people in nursing homes are to schemes in which drug companies allegedly induce pharmacies to prescribe drugs they otherwise wouldn't. The DOJ said that "J&J's kickbacks to Omnicare took multiple forms, including rebates that were conditioned on Omnicare engaging in an "Active Intervention Program" for Risperdal and payments disguised as data purchase fees, educational grants, and fees to attend Omnicare meetings." One patient cited by the government's complaint received 67 -- sixty-seven! -- different drugs under Omnicare's "care" (see list below). Those drugs included Cipro, Neurontin, Heparin, Pepcid, Oxycodone and Seroquel or their generics, according to the complaint.

Omnicare, the country's largest nursing home pharmacy chain, paid $98 million to settle the case. The WSJ Health blog noticed that the government accused J&J of paying kickbacks -- such as questionable rebates -- to Omnicare in order to persuade Omnicare to implement an "Active Intervention Program" for Risperdal.

In Johnson & Johnson's 10-Q, the company disclosed:

In September 2005, Johnson & Johnson received a subpoena from the U.S. Attorney's Office, District of Massachusetts, seeking documents related to sales and marketing of eight drugs to Omnicare ... Several employees of the Company's pharmaceutical subsidiaries have been subpoenaed to testify before a grand jury in connection with this investigation.
In April 2009, Johnson & Johnson was served with the complaints in two civil qui tam cases relating to marketing of prescription drugs to Omnicare, Inc.
Among the results of Omnicare's scheme was that a single patient in a nursing home in Massachusetts received 67 drugs from Omnicare's pharmacies. There's no suggestion that these drugs were prescribed needlessly (some patients are indeed very sick), however this patient seems to have been "cycled" through various drug categories -- hence Seroquel and Neurontin, and Pepcid and Zantac. (Ironically, Risperdal seems to be the only drug the patient didn't get.) Here's the list:

(Click to enlarge.) Note that it's so long the government couldn't fit it all onto one page. Tony West, assistant attorney general for the Civil Division of the Department of Justice, said:

Illegal conduct like this can undermine the medical judgments of health care professionals, lead to patients being prescribed medications they do not need, and drive up the costs of health care.