Orphan Drug Act Pharmaceutical Fraud Attorneys

The Orphan Drug Act, Public Law 97-414,   (ODA; “the Act”) was passed January 4, 1983 to address the glaring absence of drug development and coverage for diseases that affect only small patient populations in the US. Because of the small patient populations, the markets and corporate financial rewards for these conditions are small compared to common conditions.  The Act was aimed to increase incentives to develop Orphan drugs. Unfortunately, it also opened the door to Orphan Drug Fraud. With easier and swifter FDA approval, pharmaceutical companies had a product to sell, but the indicated population still was minute. This push-pull, with unscrupulous companies, created pressure to promote the Orphan Drugs for Off-Label promotion and in doing so, other forms of Pharmaceutical Fraud.

With passage of the ODA, the concerns of industry on  investment in orphan drug therapies were addressed in a dramatic way. The ODA provided companies with  financial incentives for drug research for these populations  (fewer than 200,000 affected patients). Incentives under the Act included (1) federal funding for clinical trials of orphan products; (2) a tax credit of 50 percent of clinical testing costs; and (3) an exclusive right to market the orphan drug for 7 years from the date of marketing approval.   Thus, these congressional incentives included tax breaks on profits, research subsidies, and extended market exclusivity. With these incentives, drug companies began developing more drugs for uncommon diseases, such that by August 2018, 503 new orphan therapies were approved, only 35 years following passage of the Act.

Additional benefits available to sponsors include close coordination and priority review by the Food and Drug Administration (FDA) , and waiver of drug application fees.  Finally, the FDA created the Office of Orphan Product Development  to facilitate this regulatory function.  In summary, the Act empowered the FDA to approve requests for orphan drug status, coordinate drug development, and award research grants.

But, in the wake of this sweeping legislation, concerns were raised both by Congress and rare disease stakeholders that exorbitant and unintended profit-taking by the pharmaceutical industry could result from the ODA protections.   When considering the hope provided by orphan drugs, the Huntington’s Disease Society of America said in 1992, ‘hope is no good if a drug is developed and our folks cannot afford it.’

A scholarly report by a pharmaceutical analytical organization, evaluating the orphan drug market, recently concluded:    

……… orphan drugs will make up one-fifth of worldwide prescription sales, amounting to $242 billion in spend in 2024 – with much of it going to either big pharma or big biotech.

 (This) will only focus the minds of those calling for reforms to the Orphan Drug Act …..the willingness of big pharma groups to pay substantial premiums to get their hands on orphan drug products demonstrates the promise these companies see in the orphan drug space……………… growth rates (in orphan drug sales) approximately double those of the overall prescription drugs market and the mean cost per patient per year of the top 100 orphan products in the US hitting $150,854 in 2018 versus $33,654 for a non-orphan drug, explain much of the allure.

And with increasing complexity surrounding reimbursement of some of the industry’s most innovative drugs, big pharma’s regulatory expertise means it is arguably better placed to – if not develop orphan drugs – buy and market them. As such the dominance of big pharma in the orphan drug market, excluding substantially policy reforms, is only likely to increase…

……………….  it might be wise to temper some of the excitement around these (orphan) products and the related growth of the orphan drug market. The promise of these new therapies will only become reality if the innovation of drug companies is matched by innovation in the drug pricing and reimbursement systems…………

A remarkable loophole is described in orphan drug regulations by the same watchdog group.  During the period of orphan drug marketing exclusivity, regulatory bodies are barred from approving the same product (made by a competing manufacturer) for the same orphan indication. A single product (known as a “new molecular entity”) may hold several separate orphan designations.  This unique chemical entity, as it may be known in drug development, may access multiple patient markets simultaneously. Thus, having financed the initial developmental costs, access to different downstream medical labelling indications can provide multiple separate market exclusivities for the same drug which can run concurrently.

Clearly the incremental cost of accessing multiple patient care markets, exploiting the identical drug entity, drops precipitously, due to virtually zero incremental research and drug development costs.  At issue is whether the incremental FDA approvals are appropriate, or what lawmakers intended when passing the Act.  What is not at issue for purposes of Pharmaceutical Fraud, is off-label promotion that is false, and the use of kickbacks to fuel prescriptions, to name a few patterns of conduct that are violative of the False Claims Act.

REAL PEOPLE making real change Meet Some of our Heroes

Kathleen Hawkins

Dignity Health
$37 million

Kathleen Hawkins, RN MSN, had been employed by Defendant, Catholic Healthcare West (CHW) for approximately 6 years when she decided she had had enough of trying to change the hospital system from within.

CHW, a California not-for-profit corporation that operated hospitals in California, Arizona, and Nevada, was at the time the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California.

CLICK FOR MORE

Joe Strom

Johnson & Johnson
$184 Million

Joe Strom contacted us in 2005. We were very grateful that he did. We immediately formed an all-star legal team and a process to stop a very harmful pharmaceutical marketing strategy. It was this process we set into motion that ultimately returned hundreds of millions of dollars to the U.S. Treasury, and a portion of that, very well-deserved, into Joe’s bank account.

Joe told us a very troubling story about the off-label promotion of a pharmaceutical drug for patients who already suffered from chronic heart failure.

CLICK FOR MORE

Bruce A. Moilan Sr.

$27 Million

Bruce Moilan was a seasoned hospital systems expert by the time he contacted our Firm. At the time he decided to file his qui tam lawsuit, he was employed by South Texas Health System as a System Director for Materials Management. In this position, he oversaw $24 million in annual purchases of supplies and equipment and helped determine budget, reduction and cost analysis throughout the contract bidding and negotiations process. His job was to insure proper implementation for purchasing, receiving and management of inventory, for McAllen Hospitals, L.P.

CLICK FOR MORE

Description
Description
Description

“I collaborated with Nolan, Auerbach and White on a broad variety of cases where whistleblowers stepped forward to disclose tactics employed by large companies to influence physicians' medical decision-making in patient care. They provide ample resources to not only optimize their client cases, but in doing so consistently leverage best medical evidence to further patient safety and resource utilization.”

— Fred Polsky M.D., Former Medical Director, CMS Zone 7 Integrity Contractor

Any Questions?

Am I potential whistleblower that matches up well with our firm?

We only want to represent amazing people.

How much will I make?

We cannot guarantee anything, but we will deliver on this promise: we will give you feedback and a prognosis within 48 hours of your submission of all details to us. We are the first healthcare fraud qui tam law firm, and have been doing only healthcare fraud whistleblower lawsuits for decades-so you can expect as accurate a picture as is possible.

Are my communications with you confidential?

They are 100% confidential. If we do not take your case, your information becomes inaccessible. We have no interest in it. Besides, it is protected by the attorney-client privilege under our lawyer regulations, and we would lose our license if we were to disclose one iota of information about you or your potential case.

    Contact Us

    Contact Us

    The more detailed the response, the more likely it is that we will be able to evaluate and determine if your potential False Claims Act case falls within our case requirements. IF IT DOES, WE WILL RESPOND TO YOU WITHIN 24 HOURS. (Names of potential defendants are not necessary at this point, should you feel more comfortable omitting them.) By law, all communications to us are 100% confidential.

    No. of Employees at the Company?
    Please read the following statement and then click "Send Form":

    Any response to your e-mail will be solely to communicate about our possible representation of you under the qui tam provisions of the False Claims Act. All e-mails submitted to us, whether we take your case or not, are 100% confidential. If we do not respond to your e-mail, then you have communicated information which we cannot address because it appears to fall outside of the False Claims Act or our case requirements.