Accepting Pharmaceutical Product as Part of Opioid Settlement Terms: Cuyahoga County’s Experience with Settlement Product
April 4, 2023
In December 2022, Teva Pharmaceuticals finalized its $4.25 billion national settlement agreement. In addition to $3.34 billion over 13 years, the agreement also offers $1.2 billion worth of Naloxone, the generic form of the overdose reversal drug Narcan, over ten years to participating jurisdictions. Jurisdictions that do not wish to accept the product as part of the offer can instead take $240 million in cash.
Some jurisdictions have already signed on to participate in agreements similar to Teva’s that offer both cash payments and products. States and jurisdictions who have or are considering entering into these agreements should consider the advice of officials from Cuyahoga County, OH.
Cuyahoga County entered into three settlements with different pharmaceutical companies and distributors in 2019. They were part of a round of bellwether cases, along with Summit County, OH, that would help determine the makeup of future settlements from the opioid litigation. The settlements with Cuyahoga and Summit counties included providing products to the two jurisdictions in addition to cash payments from the opioid pharmaceutical companies.
As part of the deal, Cuyahoga County was able to access sublingual strips, or films, of suboxone, a combination of buprenorphine and naloxone, and one of the evidence-based treatments for opioid use disorder. According to two Cuyahoga County officials, Brandy Carney, Director of Public Safety and Justice Services, and Matthew Carroll, from the Office of the Cuyahoga County Executive, who were on the frontlines of managing the settlement planning, distributing product is not as straightforward as it may seem.
According to Carney and Carroll, many county organizations initially declined the suboxone, claiming that they either didn’t fit into that agencies’ particular treatment objectives (ex. strips vs pill or shot, etc.), or it wasn’t conducive to the way they manage pharmaceutical products. The latter included issues such as already having a current system for ordering, distribution, and replacement, which also included a current shelf supply. Eventually, Carney said, they were able to find agencies with interest, but even they had only limited quantities needing filled, regardless of the medications being free of cost.
In contrast to the process to distribute the suboxone strips, using the cash component from the Cuyahoga settlements was much more straightforward. The County was able to consult with health facilities, local agencies, and community organizations about effective treatments, and then purchase and distribute products.
Recommendations to Consider
When they were asked what advice they would give to other jurisdictions who have been offered products as part of their settlement, Carney and Carroll first recommended that states and jurisdictions push to receive money instead of a donated product. It was much easier for Cuyahoga County to use the cash that they had received to invest in evidence-based interventions.
If states and jurisdictions do take products as part of a settlement, Carney suggested they first consult their local healthcare providers and community partners before deciding upon what product to receive. Carney and Carroll said that consulting their county and community partners beforehand helps to ensure that the products will be used by those who need them. Additionally, Carney added, states and counties should have a plan of where the product will go ahead of time, which will help ensure the product does not go unused.