There’s a problem with the drug Nuedexta. It’s usually used to treat pseudobulbar affect (PBA), a neurological condition that causes people to burst out in fits of uncontrollable crying or laughter. When administered to patients with PBA, Nuedexta works well. It is legal, has few side effects on PBA patients, and is under an active patent held by Avanir Pharmaceuticals. But there’s still a problem with it. It is one of the most commonly prescribed drugs, yet but the percentage of all Americans who suffer from PBA is less than 1% of the total population. As one of the most expensive drugs on the market, Nuedexta has been needlessly over-prescribed to thousands of other patients, for the sole apparent reason that pharmaceutical companies get kickbacks from the sales. And nursing homes are taking the brunt of it.
CNN recently conducted an investigation on Nuedexta, which appeared online October 12, 2017. Reporters found that majority of all Nuedexta capsules are not prescribed to PBA patients, but to residents in America’s long-term care facilities. More than 14 million capsules were dispensed in 2016 alone, earning Avanir Pharmaceuticals just short of $300 million.
Overprescribing is connected to payments from pharmaceutical companies
As crude as it sounds, simple revenue seems to be driving force. The two main ingredients in Nuedexta can be bought and combined separately for less than $1 a pill, but Nuedexta is sold for $12.60 per pill. Numerous physicians have been found to make false diagnoses for the purpose of prescribing Nuedexta and then cashing in on the profit margin. Moreover, while many other medications are overprescribed, Nuedexta stands out in terms of geographic spread and the volume of prescriptions.
For example, in recent years there have been dozens of cases of nursing homes that have systemically overprescribed Nuedexta. One nursing home in Los Angeles, California, placed 46 of its 162 patients on Nuedexta. At that same nursing home, the resident psychiatrist issued memos to employees regarding Nuedexta, seemingly in an attempt to boost their morale regarding the prevalent use of the drug.
Another high-profile incident occurred in Ohio, where a doctor paid by Avanir was investigated for possible wrongdoing. Allegedly, he deliberately misdiagnosed patients with PBA and then prescribed Nuedexta.
Nuedexta has been wrongfully prescribed for off-label uses
Overprescription isn’t the only problem. Some drugs can safely, reliably be used for applications outside of their intended purposes. But Nuedexta isn’t one of them.
Researchers returned to Los Angeles two years later and found more cases of Nuedexta abuse. In 2015, another nursing home appeared on the radar for overprescribing Nuedexta. One nurse shared that a physician residing at the nursing home had provided a diagnosis of PBA to a patient to control their moody outbursts and bouts of yelling. However, the patient had been misdiagnosed. Nuedexta isn’t been approved to treat such problems, only spontaneous outbursts of laughing and crying.
The side effects of Nuedexta can be unpleasant, even dangerous — especially for seniors. Studies have indicated that senior citizens who take Nuedexta are twice as likely to suffer from a serious fall, compared to those of identical ages who didn’t take the drug. As such, people in nursing homes should not be prescribed the drug unless its benefits — mitigating the symptoms of PBA — outweigh the higher risk of falls. By extension, seniors that don’t experience pseudobulbar affect should never be given Nuedexta.
Nuedexta has been pushed by Avanir for other conditions besides PBA. Following the initial release of Nuedexta, Avanir Pharmaceuticals began marketing Nuedexta for the treatment of dementia. However, according to the FDA, Nuedexta offers few benefits for dementia, if any.
Dementia is far more common in the United States than is PBA, and it’s possible for some individuals to be affected by both conditions. Avanir claims that as many as 40% of those with dementia can also have PBA, but other geriatric physicians interviewed by CNN said that the real number was closer to 5%. Avanir’s aggressive marketing of Nuedexta for dementia could be more related to revenue than actual healthcare need.
It seems like prescription drug companies shouldn’t be allowed to provide doctors with hefty payments, but it’s been an established process for years in the US — and in larger volumes than most are aware of. From 2013 to 2015, drug manufacturers, researchers, and distributors paid doctors and other healthcare professionals more than $6 billion in total compensation. Some select physicians have received in excess of tens of millions of dollars in the above time period — although most top-earners receive royalties for inventions they’ve contributed to.
Find a patient advocate to avoid unnecessary prescriptions
Many of the residents in nursing homes are unable or not allowed to decide for themselves whether or not they want to take the drugs they are prescribed. This is why it is critical that senior citizens in nursing homes have someone, either a relative or a professional, to advocate for their health.
Values Based Patient Advocates helps protect senior citizens against being prescribed unnecessary drugs and receiving unnecessary treatments. One of our services is helping patients understand their diagnoses and what their different prescriptions mean. You can protect yourself and your loved ones from situations like the one described by CNN — please reach out to us today.