Actiq – the off-label poster child

Actiq is a narcotic taken in lollypop form, a technique that gets the drug to the pain centers quickly. Developed for break-through cancer pain, evidence now suggests that only 10% of Actiq users have cancer.The high-powered narcotic has been the subject of several recent reports and a state attorney general investigation concerning off-label use.

Total annual sales of the drug are about $450 million. As an indication of how prevalent off-label usage has become, analysis of data from the workers compensation industry indicate over $80 million of Actiq sales are for workers compensation patients, a figure that is nothing short of stunning. The incidence of cancer in workers comp is so small as to be unmeasureable, yet employers are buying almost one-fifth of the Actiq sold for their comp claimants.
One-fifth.
According to one report, off-label usage is not accidental. Actiq’s manufacturer, Cephalon, has been accused of aggressively encouraging physicians to prescribe the drug for migraine, low back pain, and other conditions. Cephalon is currently under investigation for these activities by one state’s attorney general.
Cephalon has recently introduced a new variation of oral fentanyl (the synthetic opioid “active ingredient”) – Fentora. The intro has come just as Actiq has come off patent.
Health care managers would be well-advised to closely monitor the usage of Fentora among their insureds.