[xoxoy]

I don’t really understand the rebate strategy here. They told Purdue to literally go to CVS and tell them “we are going to pay you a bonus for every overdose you cause?”

How does CVS interplay with the doctors who are doing the actual prescribing? I guess I don’t understand how a rebate change anything at CVS. Aren’t they just filling the prescription?

[MattGaiser]

I am guessing that it was meant as legal/political/social cover? Hazard pay for the potential litigation they might face?

CVS put some limits on opioid prescriptions:

https://www.statnews.com/2017/09/21/cvs-opioid-prescription-...

[xoxoy]

isn’t CVS just doing whatever the doctor is prescribing without any judgement? i don’t see how CVS would be liable here unless they failed to verify the authenticity of a prescription or something on purpose.

[Spooky23]

CVS can choose to set metrics and implement systems to discourage noticing that one person is pulling multiple scripts, for example.

Also remember that CVS is basically a monopoly wholesaler as well as a retailer — so they can play games at that level as well like stuffing the channel to favor the manufacturer that pays them more on the backend. Railroad trusts and standard oil did the same thing in the 1900s.

This is especially true in places where states have hobbled regulatory power. Little towns in West Virginia were dispensing more opioids than counties in other places. In places with more robust regulation, the pharmacists will lose their license.

The whole thing is disgusting and really illustrates how amoral and evil outfits like McKinsey are, and how their way of thinking is a more in your face vision of what many corporate leaders believe.

[xoxoy]

yeah I guess the wording of the story is confusing. I think it’s less “here’s a reward for literally killing people” and more “here’s a little something to soften the blow of an OD so that you continue to fill Oxycotin without judgement or heavy restrictions”

[spanktheuser]

I love your phrasing... “soften the blow.”

I’m trying to imagine this 45 year old CVS VP of Product stuffing the channel with opiates & hiding the analytics on one hand. And on the other hand feeling real bad somebody somewhere ODed.

These emotions - they belong to two very different people. Who don’t like each other at all.

[Spooky23]

Come on man, the poor bastard needs to make the payments on his wife’s X5. Have a little compassion.

[Spooky23]

There’s no blow to soften. It’s a bribe.

“Your pharmacists get paid $150k to count pills and assess risk. They failed to assess risk, here’s a bonus for continuing to hire people who don’t do their job.”

[tekdude]

Pharmacies have to handle the possibility that a patient is collecting multiple prescriptions from multiple doctors to get more quantities than they need or can safely have.

[hehetrthrthrjn]

The pharmacist is supposed to make sure that the patient isn't being harmed by the medication.

That's the theory. In reality it's just as you say.

[lotsofpulp]

No, it’s not. Pharmacists are tasked with refusing to fill prescriptions they believe are harmful, and routinely reject combinations of medicines if they are harmful. And the DEA is putting pressure on pharmacies to refuse prescriptions for suspected opioid abusers, so many large pharmacy companies have many limits in place regardless of what the doctor writes.

If you walk into a pharmacy with just an opioid prescription, and you’re not a regular or something seems off such as it’s hand written, chances are you’re going to get denied or at least won’t get your medication until they call the doctor and discuss why you need it.

All the states even have a PDMP - prescription drug monitoring program - that pharmacies have to check before dispensing opioids to confirm the person’s prescription history.

[MattGaiser]

It doesn't prevent them from being sued and incurring costs as a result or having to spend resources complying with investigations.

[xoxoy]

ok, so a rebate is less “here’s a reward for OD’ing people” and more “we’ll soften the blow if you continue filling Oxy with no judgment if someone ends up dying” I guess

[Spooky23]

No, it’s more Purdue and McKinsey modeled the overdose rates based on market performance of OxyContin. Overdoses were a metric, provided for free by the county health departments, that was a proxy for sales performance.

It is a murder bonus; it proceduralized a public health crisis.

[jrumbut]

Pharmacies, in practice, have some autonomy in what they do and especially in what they make it easy to do.

If you have a doctor who writes prescriptions by hand try taking it to different pharmacies, you'll find the procedures are rather different.

[bhickey]

The pharmacist might be otherwise discouraged from keeping oxy in stock.

[spanktheuser]

Whenever someone says “liable” I know they’ve stopped arguing about justice and begun arguing about proper application of laws lobbyists purchased from Congress.

[jrochkind1]

Same question. They decided to INCENTIVIZE overdoses? (And "opioid use disorders" too, they were paying rebates for those too).

I don't understand either the ethical OR business sense of this. Very confused.

I haven't been paying too too much attention to this stuff, and I never before felt like saying anyone should face prison over any of this -- but incentivizing overdoses, are you serious? I feel like anyone involved in that decision is a horrible human being, at the least.