by Max Brantley
Mother Jones has some strong additional reporting on details that led to a $3 billion settlement — the largest fraud settlement ever — with GlaxoSmithKline over, among others, kickbacks, illegal marketing of drugs and encouraging state medical programs to prescribe their drugs for off-label uses.
Most interesting Arkansas angle, from Justice Department documents:
In 2006, Arkansas Medicaid restricted its coverage in off-label use of Advair by requiring that patients try another medication first. "Arkansas Medicaid determined that this restriction increased appropriate use of Advair and decreased Advair utilization by 25% without adverse impact on patient care," the US complaint reads. GSK then allegedly gave an untold sum of campaign donation dollars to an Arkansas lawmaker who introduced legislation to get rid of the restriction. "God save political donations," wrote one GSK employee to senior VP Stan Hull in an internal email.
Shouldn't take too long to run this down. Among others, I've asked the attorney general's office, which investigates Medicaid fraud and which proudly announced participation in the Glaxo settlement, if it had looked into this suggestion of a quid pro quo with an Arkansas lawmaker.
This doesn't conclusively fill in the blank, but ....
In 2009, Sen. Joyce Elliott of Little Rock introduced and passed this bill to study the effects of Medicaid rules on use of asthma medication. It did not remove the rule, but it did call for a study of the imapct of removing the limitation to which the drug company objected.
This legislation did follow not long after a July 2008 contribution of $2,000 by GlaxoSmithKline to Elliott's state Senate campaign.
The Glaxo PAC also contributed $2,000 to her 2010 race for Congress.
UPDATE: I've reached both Elliott and Glaxo's local lobbyist, who dispute any deal on the legislation. Elliott notes that she became convinced through the study her bill authorized that there wasn't evidence sufficient to change the rule to which Glaxo objected.
Michael Mitchell, a Little Rock lawyer who lobbied for Glaxo then and now, summarizes his response to the insinuation: "Baloney."
Mitchell said he'd worked on the issue with Elliott and she sponsored the legislation because of a concern for equal treatment of asthmatic kids under Medicaid. Mitchell said a doctor with a patient covered by private insurance could prescribe Advair from the outset. Under Medicaid rules, a doctor first had to try and fail with cheaper treatment alternatives before prescribing Advair.
Mitchell said Elliott's bill did not change the rule, but called for a review. He said it led to one well-attended hearing and Medicaid officials continued to argue for the cost-saving feature of the rule. As a result, he said the matter was dropped and no change was made.
Mitchell said that, as local lobbyist for Glaxo, he'd recommended that the company give Elliott a campaign contribution.
"She's a good legislator. She's very concerned about equal treatment of kids in Medicaid with kids with private payers."
A quid pro quo?
"That's crazy," Mitchell said. "I don't make deals. I never have and I never will. I don't conduct business that way."He acknowledged that contributions will go to legislators according to things a lobbyist might like about what a legislator "does or doesn't do," but he said, "The very notion that you make a contribution and there's some kind of contract, that's just baloney."
Elliott said she'd sponsored the legislation because of the number of African-American children with asthma and reports from doctors about their difficulty in prescribing the most effective medicine for their patients. "That piqued my interest," she said. "I filed the bill for study because I didn't know what was going on."
She said the hearing and other study helped her get to the bottom of available evidence. "I didn't see a way to change it," she said. She was convinced that the Medicaid rule made sense or, at least, there was no evidence of a better way to control prescribing practices.
As for the suggestion that she introduced the legislation because of a campaign contribution:
"Thats absolutely not the case. I've had campaign contributions via Mike Mitchell before and they had nothing to do with anything."