Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T08:37:24.067Z Has data issue: false hasContentIssue false

Generic Drug Policy and Suboxone to Treat Opioid Use Disorder

Published online by Cambridge University Press:  01 January 2021

Abstract

Despite some improvements in access to evidence-based medications for opioid use disorder, treatment rates remain low at under a quarter of those with need. High costs for brand name products in these medication markets have limited the volume of drugs purchased, particularly through public health insurance and grant programs. Brand firm anti-competitive practices around the leading buprenorphine product Suboxone — including product hops, citizen petitions and Risk Evaluation and Mitigation Strategy abuses — helped to maintain high prices by extending brand exclusivity periods and hindering generic drug entry. Remedies to address costly anti-competitive activities include adoption of the proposed CREATES Act and modernization of the Hatch-Waxman Act by the Congress, and implementation of substantive modifications to the Food and Drug Administration citizen petition filing procedures. Given the persistence of these abuses, prescriptive changes are favorable to the procedural and clarifying steps thus far favored by the federal government. Extrapolating from the 37% price declines attributable to generic entry for buprenorphine tablets in 2011, our calculations suggest that implementing these remedies to facilitate generic competition with Suboxone film would have resulted in savings of approximately $703 million overall and $203 million to Medicaid in 2017.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hedegaard, H., Miniño, A.M., and Warner, M., “Drug Overdose Deaths in the United States, 1999–2017,” National Center for Health Statistics Data Brief, No. 329 (Nov. 2018), available at <https://www.cdc.gov/nchs/products/databriefs/db329.htm> (last visited December 4, 2019); Charumilind, S., Latkovic, T., Lewis, R., and Mendez-Escobar, E., “Why We Need Bolder Action to Combat the Opioid Epidemic,” McKinsey & Company Report, (2018), available at <https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/why-we-need-bolder-action-to-combat-the-opioid-epidemic> (last visited December 4, 2019); Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Behavioral Health Statistics and Quality, “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health,” HHS Publication No. SMA 18-5068, NSDUH Series H-53 (2018); Saloner, B. and Karthikeyan, S., “Changes in Substance Abuse Treatment Use Among Individuals with Opioid Use Disorders in the United States, 2004-2013,” JAMA 314 (2015): 1515-1517, at 1515; Lembke, A. and Chen, J.H., “Use of Opioid Agonist Therapy for Medicare Patients in 2013,” JAMA Psychiatry 73, no. 9 (2016): 990-992, at 990; Sandoe, E., Frye, C. and Frank, R., “Policy Levers that States Can Use to improve Opioid Addiction Treatment and Address the Opioid Epidemic,” Health affairs Blog, Oct. 2, 2018, available at <https://www.healthaffairs.org/do/10.1377/hblog20180927.51221/full/> (last visited December 4, 2019).Google Scholar
Haffajee, R.L., Bohnert, A.S.B., and Lagisetty, P.A., “Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment,” American Journal of Preventive Medicine 54, no. 6 (2018): S230-S242, at S230-235; Pitt, A.L., Humphreys, K., and Brandeau, M.L., “Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic,” American Journal of Public Health 10 (2018):1394-1400, at 1394; Larochelle, M.R., Bernson, D., Land, T., et al., “Medication for Opioid use Disorder After Nonfatal Opioid Overdose and Association with Mortality: A Cohort Study,” Annals of Internal Medicine 169, no. 3 (2018): 137-145, at 137; Schwartz, R.P., Gryczynski, J., O'Grady, K.E., et al., “Opioid Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995–2009,” American Journal of Public Health 103, no. 5 (2013): 917-922, at 917; Walley, A.Y., Xuan, Z., Hackman, H.H., et al., “Opioid Overdose Rates and Implementation of Overdose Education and Nasal Naloxone Distribution in Massachusetts: Interrupted Time Series Analysis,” BMJ 346 (2013): f174; Sordo, L., “Mortality Risk During and After Opioid Substitution Treatment: Systematic Review and Meta-Analysis of Cohort Studies,” BMJ 357 (2017): j1550, available at <https://doi.org/10.1136/bmj.j1550> (last visited December 4, 2019).CrossRefGoogle Scholar
21st Century Cures Act, P.L. 114-255 (2016); the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, P.L. 115-271 (2018).Google Scholar
Drug Price Competition and Patent Term Restoration Act, P. L. 98-417 (1984).Google Scholar
Schuckit, M.A., “Treatment of Opioid-Use Disorders,” New England Journal of Medicine 374, no. 4 (2016): 357-368, at 361-363; PEW Charitable Trusts, Medication-Assisted Treatment Improves Outcomes for Patients with Opioid Use Disorder (2016), available at <https://www.pewtrusts.org/-/media/assets/2016/11/medicationassistedtreatment_v3.pdf> (last visited December 4, 2019); Substance Abuse and Mental Health Services Administration, “Buprenorphine,” 2019, available at <https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine> (last visited December 4, 2019).Google Scholar
21 U.S.C. § 801. Controlled Substances Act (1970).Google Scholar
See Substance Abuse and Mental Health Services Administration, supra note 7.Google Scholar
Reckitt Benckiser Pharmaceuticals Inc., “Safety Concerns Regarding Buprenorphine For Opioid Dependence,” 505(q) filing (2012), available at <https://www.naabt.org/documents/Reckitt_Benckiser_Pharmaceuticals_Inc_2012_FDA_Citizen_Petition.pdf> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Complaint, supra note 5, at 14.Google Scholar
Indivior, “About,” 2019, available at <http://www.indivior.com/about/our-history/> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
IQVIA, “Transactional Data Warehouse: All Buprenorphine Sales by Product, 2009-2017”.Google Scholar
See Indivior, supra note 13.Google Scholar
The Medical Letter, “Buprenorphine Implants (Probuphine) for Opioid Dependence,” JAMA 316, no. 17 (2016): 1820-1821, at 1820-21.CrossRefGoogle Scholar
Jensen, K., “Dr. Reddy's Relaunches Suboxone Generic after Court Victories,” BioPharma Dive, Feb. 22, 2019, available at <https://www.biopharmadive.com/news/dr-reddysrelaunches-suboxone-generic-after-court-victories/548907/> (last visited December 4, 2019). (last visited December 4, 2019).' href=https://scholar.google.com/scholar?q=Jensen,+K.,+“Dr.+Reddy's+Relaunches+Suboxone+Generic+after+Court+Victories,”+BioPharma+Dive,+Feb.+22,+2019,+available+at++(last+visited+December+4,+2019).>Google Scholar
Alexander, P., “As Manufacturer of Leading Addiction Drug Comes under Legal Fire, A New Competitor Emerges,” Huff Post, Oct. 27, 2016, available at <https://www.huffpost.com/entry/as-manufacturer-of-leading-addiction-drug-comes-under_b_5811abb4e4b08301d33e058f>; Indivior, “2015 Annual Report,” 2016, available at <http://www.indivior.com/2015-annual-report/indivior-07-us-competition/> (last visited December 4, 2019).;+Indivior,+“2015+Annual+Report,”+2016,+available+at++(last+visited+December+4,+2019).>Google Scholar
Drug Price Competition and Patent Term Restoration Act, P. L. 98-417 (1984).Google Scholar
Congressional Research Service, “The Hatch-Waxman Act: A Primer,” CRS Report R44643 (2016): 1-16, at 3-9.Google Scholar
Feldman, R. and Frondorf, E., “Drug Wars: A New Generation of Generic Pharmaceutical Delay,” Harvard Journal on Legislation 53, no. 1 (2016): 499-780.Google Scholar
Id.; Complaint, supra note 5, at 10-11.Google Scholar
Feldman and Frondorf, supra note 23.Google Scholar
Fowler, A.C., “Pharmaceutical Line Extensions in the United States: A Primer on Definitions and Incentives,” NBER White Paper, Oct. 6, 2017, available at <http://www.nber.org/aging/valmed/WhitePaper-Fowler10.2017.pdf> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Berndt, E.R. and Aitken, M.L., “Brand Loyalty, Generic Entry and Price Competition in Pharmaceuticals in the Quarter Century after the 1984 Waxman-Hatch Legislation,” International Journal of the Economics of Business 18, no. 2 (2011): 177-201; Complaint, supra note 5, at 11-12.Google Scholar
Complaint, supra note 5, at 20-24.Google Scholar
U.S. Food and Drug Administration, “Risk Evaluation and Mitigation Strategies (REMS),” Feb. 2, 2018, available at <https://www.fda.gov/drugs/drug-safety-and-availability/risk-evaluation-and-mitigation-strategies-rems> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Dabrowska, A., “FDA Risk Evaluation and Mitigation Strategies (REMS): Description and Effect on Generic Drug Development,” Congressional Research Service Report 7-5700, Mar. 16, 2018, available at <https://fas.org/sgp/crs/misc/R44810.pdf> (last visited December 4, 2019): at 5.Google Scholar
Id., at 6-7.Google Scholar
Id., at 10-12.Google Scholar
Brill, A., “Lost Prescription Drug Savings from Use of REMS Programs to Delay Generic Market Entry,” July 2014, Matrix Global Advisors, available at <https://static1.1.sqspcdn.com/static/f/460582/25228342/1406034596510/REMS_Study_July.pdf> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Dabrowska, supra note 30, at 9.Google Scholar
Actelion Pharmaceuticals Ltd. et al. v. Apotex Ltd., et al., 1:12-cv-05743-NLH-AMD (D. NJ, 2013); Center for Drug Evaluation & Research, Food & Drug Administration, “Standardizing and Evaluating Risk Evaluation and Mitigation Strategies (REMS)” Report, Sept. 2014, available at <https://www.fda.gov/files/about%20fda/published/Standardizing-and-Evaluating-Risk-Evaluation-and-Mitigation-Strategies-(REMS).pdf> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Dabrowska, supra note 30, at 11.Google Scholar
Feldman and Frondorf, supra note 23.Google Scholar
21 C.F.R. § 10, 1979.Google Scholar
Buehler, G., “Improving Access to Generic Drugs,” Center for Drug Evaluation & Research, Food & Drug Administration Senate Testimony, 2006.Google Scholar
Food and Drug Administration Amendments Act, P.L. 110-85 (2007).Google Scholar
Carrier, M.A. and Minniti, C., “Citizen Petitions: Long, Late-Filed, and at-Last Denied,” American University Law Review 66 (2016): 305-351.Google Scholar
Id.; Feldman, R. and Wang, C., “A Citizen's Pathway Gone Astray — Delaying Competition from Generic Drugs,” New England Journal of Medicine 376, no. 16 (2017): 1499-1501, at 1499-1500.CrossRefGoogle Scholar
Feldman and Wang, supra note 46, at 1500; Carrier, M.A. and Wander, D., “Citizen Petitions: An Empirical Study,” Cardozo Law Review 34, no. 1 (2012): 101-146.Google Scholar
Reckitt Benckiser Pharmaceuticals, Inc., Citizen Petition, No. FDA-2012-P-1028, Sept. 25, 2012, available at <https://www.naabt.org/documents/Reckitt_Benckiser_Pharmaceuticals_Inc_2012_FDA_Citizen_Petition.pdf> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Monosol Rx, Citizen Petition, No. FDA-2013-P-0995-0001, Aug. 2013, available at <https://www.regulations.gov/document?D=FDA-2013-P-0995-0001> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Complaint, supra note 5, at 2-7.Google Scholar
Indivior, “Indivior Enters into Settlement with Par Pharmaceutical in Patent Infringement Case,” May 14, 2018, available at <http://www.indivior.com/investor-news/indivior-enters-settlement-par-pharmaceutical-patent-infringement-case/> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Memorandum Opinion, State of Wisconsin, et al. v. Indivior Inc. f/k/a Reckitt Benckiser Pharmaceuticals Inc., et al, 2:15-cv-01621-MSG (E.D. Pa decided Oct. 25, 2017).Google Scholar
U.S. Department of Justice, “Press Release: Indivior Indicted for Fraudulently Marketing Prescription Opioid,” Apr. 9, 2019, available at <https://www.justice.gov/opa/pr/indivior-incindicted-fraudulently-marketing-prescription-opioid> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Faulkner, J., “Reckitt to Pay $1.4B to End US Opioid Probe,” Law360, July 11, 2019, available at <https://www.law360.com/articles/1177241> (last visited December 4, 2019).+(last+visited+December+4,+2019).>Google Scholar
Senate Permanent Subcommittee on Investigations, Combatting the Opioid Crisis: The Price Increase of an Opioid Overdose Reversal Drug and the Cost to the U.S. Health Care System Combatting the Opioid Crisis, Committee on Homeland Security (2018).Google Scholar
Feldman and Frondorf, supra note 23.Google Scholar
Clemans-Cope, L., Epstein, M., and Kenney, G.M., “Rapid Growth in Medicaid Spending on Medications to Treat Opioid Use Disorder and Overdose,” Urban Institute (2017): 1-12.Google Scholar
Feldman and Frondorf, supra note 23.Google Scholar
Iyengar, V., “Should Pharmaceutical Product Hopping Be Subject to Antitrust Scrutiny,” Journal of the Patent and Trademark Office Society 97, no. 4 (2015): 663-689.Google Scholar
Frank, R.G. and Haffajee, R.L., “Generic Drug Policy and Opioid Use Disorder Treatment,” Laura & John Arnold Foundation White Paper 1 (2019): at 27-28.Google Scholar
Frank, R.G. and Hartman, R.S., “The Nature of Pharmaceutical Competition: Implications for Antitrust Analysis,” International Journal of the Economics of Business 22, no. 2 (2015): 301-343.CrossRefGoogle Scholar
Dabrowska, supra note 30, at 5-8.Google Scholar
“The Lower Health Care Costs Act,” S. 1985 (sponsored by Sen. L. Alexander), introduced Jun. 19, 2019.Google Scholar
“The Creating and Restoring Equal Access to Equivalent Samples Act of 2018 (CREATES Act),” S. 340 (sponsored by Sen. P. Leahy), introduced Feb. 5, 2019.Google Scholar
Food and Drug Administration, “Proposed Guidance: Citizen Petitions and Petitions for Stay of Action Subject to Section 505 (q) of the Federal Food, Drug, and Cosmetic Act, Guidance for Industry,” (2018): 1-17.Google Scholar
21 U.S.C. §255(a)(1)(E).Google Scholar
Feldman and Wang, supra note 46, at 1500.Google Scholar
Evans, E., “Citizen Petitions: A Process Hijacked by Big Pharma?” Emory Corporate Governance and Accountability Review 5 (2017): 115-120.Google Scholar
Id.; Feldman and Wang, supra note 46, at 1499-1500.Google Scholar
Buehler, G., “Senate Testimony: Improving Access to Generic Drugs,” Center for Drug Evaluation & Research, Food & Drug Administration (2006).Google Scholar
Evans, supra note 75.Google Scholar
21 U.S.C. §255(a)(1)(E).Google Scholar
Carrier, M.A., “Five Actions to Stop Citizen Petition Abuse,” Columbia Law Review Online 118, no. 3 (2018): 81-92.Google Scholar