Andover pharmacy under investigation for opioid dispensing

Editor’s note: This story was updated Thursday.

Attorney General Maura Healey is investigating whether an Andover pharmacy that specializes in workers compensation patients properly dispensed controlled substances, a spokeswoman said Wednesday.

The Injured Workers Pharmacy, a national mail-order pharmacy, was recently revealed to be the largest recipient of opioid pills in Massachusetts during 2006 to 2012, in data from the Drug Enforcement Administration.

Healey’s investigation started before that information came to light last week, the spokeswoman said.

The Injured Workers Pharmacy received 34.3 million pills during that time period, almost three times more than the next biggest recipient in Massachusetts, according to the data, which was released after a lawsuit by The Washington Post and HD Media, publisher of the Charleston Gazette-Mail in West Virginia.

The pharmacy has a national clientele and caters to injured workers. It currently ships more than 40,000 prescriptions nationwide, according to its website.

“The DEA data regarding opioids received by Massachusetts pharmacies presents a misleading comparison because the quantities received by IWP are dispensed to patients across the country, whereas at least the next seven largest recipients of opioids are retail pharmacies which dispensed in small areas within the state,” said a statement from the pharmacy’s lawyer, Greg Saikin, partner in the law firm of BakerHostetler.

“IWP is fully cooperating with an inquiry by the Massachusetts Attorney General’s Office — and is aware that Attorneys General across the country are likewise looking into all aspects of companies in the pharmacy value chain. IWP prides itself on compliance with federal and state laws, and goes above and beyond what the laws require in its commitment to patient and public safety.”

Joseph Paduda of Health Strategy Associates, a consultant who specializes in workers compensation, said IWP is owned by private equity investors and has been operating for 12 to 15 years.

“Their business model is essentially to identify attorneys that represent workers comp claimants and convince those attorneys to utilize IWP or encourage clients to utilize IWP,” Paduda said.

The pharmacy will provide prescribed medications even if the insurance company rules that the drugs are inappropriate, he said. Lawyers in many states are compensated as a percentage of the total settlement, so they will make more money if more treatment is provided, Paduda explained.

But IWP argues that an insurance company’s denial of payment has no bearing whether or not the medications were medically necessary, and that an insurer’s decision is unrelated to the medical judgment of the prescribing physician.

The DEA data caught the attention of US Representative Lori Trahan, who praised Healey for “her efforts to hold actors like Purdue, IWP, and others accountable for their role in this public health crisis.”

“We are going to need a multipronged approach to dealing with the opioid addiction crisis,” Trahan said in a statement. She added that she plans to file legislation that would “require prescribers of controlled substances to be trained on preventing, identifying, treating, and managing patients with opioid and other substance disorders.”

Healey’s office has been active in pursuing pharmacies over opioid prescribing. In September 2016, she reached a settlement with CVS after finding that its pharmacists had improperly dispensed opioids to patients flagged as high risk because they receive prescriptions for large quantities of the painkillers. The Rhode Island-based drugstore chain paid a $795,000 fine and agreed to require its pharmacists to consult a database of prescriptions before dispensing powerful painkillers.

In January 2017, Walgreens agreed to pay $200,000 and follow certain procedures after Healey found that some Walgreens pharmacies failed to monitor patients’ drug use patterns and didn’t use sound professional judgment when dispensing opioids and other controlled substances.

And in January of this year, the Rite Aid chain agreed to pay $177,000 and to follow state Medicaid rules on dispensing opioids and other drugs. Healey accused Rite Aid of accepting cash payments for controlled substances from Medicaid recipients “in a limited number of instances,” instead of billing the agency as required by regulations. In some cases, court documents stated, Medicaid had denied a claim for a controlled substance on the same day as a Rite Aid pharmacist dispensed it for cash.

According to The Washington Post, the newly released DEA data showed that 76 billion oxycodone and hydrocodone pain pills flooded the nation from 2006 to 2012. Massachusetts pharmacies received 1.3 million pills during that period.