Politico on 06/22/2018 by ADAM CANCRYN
The House is touting passage of dozens of bills that could help combat the national opioid crisis — but a small handful of companies that have spent millions lobbying Congress could reap a windfall if any of the bills become law.
In a two-week legislative blitz, the House cleared several narrowly tailored measures that would spur sales for companies that have ramped up their influence game in Washington, according to a review of the more than five dozen bills up for votes.
Those poised to benefit include:
• Alkermes, which spent $1 million lobbying in part to support a bill to fund full-service centers where people can detox, receive medical care and start treatment — a setup that could boost the fortunes of its best-selling product, anti-addiction treatment Vivitrol, which has been held back by the need for patients to fully detox before taking the drug.
• Indivior, an Alkermes rival that spent $180,000 largely in support of a bill that eases restrictions on certain controlled substances used in injectable anti-opioid treatments — a change that would make it easier for doctors to buy Indivior’s once-a-month injectable Sublocade.
• Pennsylvania drugmaker Braeburn Pharmaceuticals, which spent $100,000 lobbying and backed the same bill because it is developing a competing injectable.
• A group of drugmakers that produce non-opioid pain relief medications, including California-based Heron Therapeutics, which spent hundreds of thousands to lobby for legislative changes to create an additional Medicare payment for non-opioid pain drugs.
The measures come as part of a House package that anti-addiction advocates and even some lawmakers say will make only incremental progress toward fighting a public health crisis that’s killing an estimated 115 Americans per day.
“This is a very energetic effort to pretend we’re doing something significant,” said Rep. Peter Welch (D-Vt.), who supported the package but stressed the need to devote greater resources to the opioid fight. “By and large it’s better to do than not, but it falls way short of what is required.”
Yet as the epidemic morphs into a major campaign issue — and Congress runs out of time to pass other legislative packages — interest in the opioid effort has ballooned. Congress used February’s budget deal to authorize spending $6 billion over two years to address the crisis, prompting more than 300 companies and interest groups to flood Capitol Hill to lobby on opioids during the first three months of 2018, according to disclosure forms.
“When you hear they’re investing $3 billion in this in 2018 and $3 billion in 2019, everyone’s ears are going to perk up,” said Andrew Kessler, the founder of behavioral health consulting firm Slingshot Solutions. “For years, we got the scraps. And now we’re the big time.”
Alkermes, a big potential winner, has already attracted attention for its aggressive marketing tactics and Washington lobbying presence. Former HHS Secretary Tom Price toured the company’s Wilmington, Ohio, plant last year to tout Vivitrol — stirring controversy by belittling rival medication-assisted treatments that are more widely-used.
Alkermes spent $1 million lobbying Congress from January through March, focusing on a bipartisan bill from Reps. Brett Guthrie and Gene Green that directs millions of dollars to create full-service centers where people can detox, receive medical care and start treatment under the same roof. The proposal, passed last week in the first wave of House opioid votes, attempts to address the difficulty many patients face finding comprehensive treatment, the lawmakers said.
It also neatly addresses a chief problem holding back Alkermes’ best-selling product: While Vivitrol is one of just three FDA-approved drugs treating opioid addiction, it’s the only one that requires patients to fully detox before taking it.
That’s a major roadblock for doctors who are often unsure whether a patient has been in withdrawal for at least a week, and for patients desperate for immediate treatment, crimping Vivitrol’s market potential just as providers increasingly embrace medication-assisted treatment.
“The issue with Vivitrol is the fact that 25 percent of patients fail the detox component and therefore relapse, and is also one of the reasons why patients prefer Suboxone or Sublocade,” said Biren Amin, a pharmaceutical analyst for Jefferies LLC, referring to competing treatments. “Vivitrol growth [is] clearly impacted.”
By contrast, doctors in the recovery centers proposed by Guthrie and Green could closely monitor and manage patients’ progress, and then start treatment as soon as they’re fully detoxed.
The bill was one of only two opioid bills that Alkermes targeted in its lobbying, according to disclosure documents. Of the four main lobbyists for the company on the issue, one previously served as Guthrie’s deputy chief of staff. Another was Green’s former legislative director.
Both Guthrie and Green rejected any suggestion the bill was written to benefit Alkermes, pointing to its support from anti-addiction groups. The bill doesn’t mandate the recovery centers use one medication over another.
“We met with all the stakeholders,” Guthrie said. “We just think most people need access to all the [treatment] options.”
In a statement, Alkermes highlighted the legislation’s broad support, adding that it “is not about a particular form of treatment, but rather focuses on … comprehensive care.” The company said it has always supported using all FDA-approved medications for opioid dependence.
Though Alkermes ranked among the biggest-spending companies on opioid issues, it’s far from the only firm spending large sums to capture Congress’ attention.
“Whoever’s stuff is slick gets put to the top of the pile,” one longtime behavioral health lobbyist said of the corporate muscle that’s descended on Capitol Hill.
Indivior backed a bill from Rep. Ryan Costello that would ease restrictions on certain controlled substances used in injectable anti-opioid treatments — an arcane but important change that would effectively make it easier for doctors to buy Indivior’s once-a-month injectable Sublocade. Some view injectable treatments as preferable because they’re less likely to be diverted or misused.
The legislative tweak — which has already passed the Senate — is the only specific House opioid bill that Indivior listed in disclosures showing $180,000 spent on lobbying in the year’s first three months.
Braeburn Pharmaceuticals, which is developing a competing injectable anti-opioid treatment, spent $100,000 over that same period and also listed the Costello bill as the only provision in the House package it focused on.
Indivior did not respond to specific questions about its lobbying effort, saying in a statement that “government policies impacting these treatments must adapt toensure patients have access to all evidence-based treatment options.”
Braeburn said the bill simply codifies prior understandings, and that it supports policies that open up access to all treatments for opioid use disorder.
A spokeperson for Costello said he supports medical innovation and expanding access to a variety of anti-opioid treatments, and noted the bill passed unanimously out of the Energy and Commerce Committee. The legislation wasn’t initially rolled into the House’s main opioid package, but could still be added or passed separately.
Other bills proposed in the House are more direct in the way they would help specific companies.
A small group of post-surgery pain drug makers, including Heron Therapeutics, stand to benefit from Rep. Scott Peters’ legislation creating an additional Medicare payment for certain non-opioid pain drugs.
Heron, which is developing a treatment that would qualify for the payment, spent $40,000 lobbying on rate-setting issues for post-surgical non-opioid drugs from January to March.
The company is headquartered in Peters’ district, and said in an email that it has discussed opioid and addiction policies with the California lawmaker. But it emphasized that none of its currently approved drugs would benefit from the proposal, and that drugs made by other companies could also qualify.
A spokesperson for Peters said he met with Heron employees and toured the company’s headquarters as part of his interest in promoting post-surgery opioid alternatives, but he also met with other groups and developed the bill’s language in coordination with federal health officials and other lawmakers.
A bipartisan effort led by Reps. John Shimkus (R-Ill.) and Raja Krishnamoorthi (D-Ill.), meanwhile, reverses deep cuts to reimbursements for select interventional pain management techniques.
That qualifies as a victory for the main trade group representing doctors who use non-opioid methods — including epidurals and other injections — to manage pain. In a celebratory blog post, the American Society of Interventional Pain Physicians said it turned to Congress to restore its pay levels after unsuccessfully lobbying federal health officials.
“The agency said heck no, we can’t touch it — it needs a legislative fix to be more specific in the intent of Congress,” Shimkus said about when he stepped in. He added that the higher pay rate is needed because those more invasive pain management techniques are often more expensive than prescribing opioids.
A spokesperson for Krishnamoorthi said the lawmaker’s interest stemmed from his support for non-opioid alternatives, and that he never personally met with ASIPP about the legislation. ASIPP’s PAC has donated the maximum $10,000 allowed for this election cycle to both support for the bill.
Behavioral health and anti-addiction advocates have largely shrugged off those narrow provisions, saying they’re a byproduct of a fast-moving, piecemeal effort to address a public health crisis.
Yet they also acknowledge it means crucial funds will be limited to select groups instead of the broader population.
That only heightens the importance of Congress continuing to pursue new proposals for curbing drug abuse, Slingshot Solutions‘ Kessler said.
“There’s a lot of good stuff in there,” he added. “However, there’s a lot to be very, very cautious of as well. And the reason is because as much attention as Congress is paying and as much money as they’re dedicating to it, we’re still not anywhere close to where we need to be.”