An Arizona doctor has been fired from a state committee and could be investigated by law enforcement after a media investigation revealed he took more compensation from drug companies than any other pharmaceutical board member in the United States.

Gov. Doug Ducey has told Dr. Mohamed Ramadan to resign from Arizona’s volunteer Medicaid Pharmacy & Therapeutics Committee after The Arizona Republic inquired about the doctor’s potential conflicts of interest.

The governor also asked law enforcement to investigate Ramadan and planned to order increased transparency measures for the state committee.

Ramadan has earned $700,000 in speaking fees, travel and meals from drug companies since 2013, federal data shows. He is a psychiatrist and medical director of Mohave Mental Health Clinic in Bullhead City.

Ramadan collected more payments than any other member of any Medicaid pharmaceutical board across the country, according to an investigation of drug maker influence by the Center for Public Integrity and National Public Radio.

Ducey decided to order Ramadan’s removal, investigation and the policy changes after The Republic asked the Governor’s Office this week to comment on the report.

“Decisions about drug coverage should be made based on empirical data and should not be unduly influenced by pharmaceutical and medical device companies,” Ducey said.

Ramadan told The Republic his decisions as a committee member and a physician are not influenced by compensation from drug makers.

“Our role is to evaluate the scientific evidence of the safety, efficacy, effectiveness and clinical appropriateness of prescription drugs,” Ramadan said in a written statement. “We do this in an unbiased manner, focusing on the best clinical evidence and cost effectiveness.”

Hundreds of free meals and trips

The state’s Pharmacy & Therapeutics Committee helps decide which drugs should be prescribed more frequently than others to the nearly 2 million people enrolled in the state’s public-health program for the poor and disabled.

The $12 billion taxpayer-funded agency is known locally as the Arizona Health Care Cost Containment System.

Republic review of compensation records showed Ramadan received nearly 350 meals and visited close to 100 cities on pharmaceutical companies’ dime over the past five years.

The cities included Las Vegas, Denver,West Palm Beach, Florida, Boston and Honolulu.

Ramadan’s consulting and speaking fees averaged more than $100,000 each year, according to payment records.

“The work a physician does with pharmaceutical companies is already highly regulated.  I have strictly complied with all pertinent regulations,” Ramadan said. “However, I would support and adhere to any new regulations that are implemented.”

At least six other members of the state committee also received gifts from drug makers, The Republic found. Each took a total of $5,000 or less since 2013.

Influence of drug companies

The investigation by the Center for Public Integrity and NPR demonstrated how drug companies court doctors who serve on Medicaid pharmaceutical committees in an attempt to get their medications on a state’s “preferred drug list.”

Convincing a committee to put a drug on the preferred list can be lucrative to pharmaceutical companies because the medications are easier for doctors to prescribe.

The preferred list is supposed to help Medicaid agencies keep taxpayer costs down by promoting prescriptions that are effective but also affordable.

The list discourages doctors from doling out costlier or less effective drugs by requiring additional paperwork.

RELATED:  In battle vs. opioid addiction, AZ’s Medicaid program favors 1 drug

Even with preferred drug lists, Medicaid nearly doubled its spending on medication nationally to $31 billion from 2008 to 2016, the media outlets reported.

Offering speaker fees, free dinners and all-expenses-paid conferences where state Medicaid officials can rub elbows with drug representatives aren’t the only strategies pharmaceutical manufacturers use to boost their bottom lines.

Some drug companies have gone as far as opening patient files in violation of privacy laws and calling Medicaid pretending to work in doctors’ offices to help physicians fill out the extra paperwork for prescriptions that are not preferred, the Center for Public Integrity and NPR learned.

The hardball tactics at times cause Medicaid to overspend or pay for medicines that patients can do without, the media outlets said.

Research shows doctors who receive gifts from pharmaceutical companies — even as little as $20 — more frequently prescribe that manufacturer’s drugs, the investigation said.

Because states spend a large part of their budgets on Medicaid, any cost increase can take resources away from schools, roads and law enforcement.


Republic reporter Rebekah L. Sanders is here with #HereToHelpAZ to help you with any consumer-protection issues you may have. Isabel Greenblatt/

Ramadan’s votes

Ramadan voted in 2017 at least once in favor of adding medications made by companies who paid him to Arizona’s preferred drug list, a Republic review of committee meeting minutes found.

He was present at a 2016 meeting where the drugs were recommended but it was unclear whether he voted that that time. No vote was recorded in the meeting minutes.

State law prohibits committee members who have a conflict of interest from participating in discussions and votes about that issue, the governor said in the executive order he’s expected to sign Friday.

The statute that Ducey cited states violations can bring felony charges.

Ducey’s office said Ramadan will be referred to law enforcement for investigation.

Other committee members who have taken gifts could be referred as well, governor spokesman Daniel Scarpinato said.

It’s unclear how much sway Ramadan had on other members’ decisions because the committee’s final deliberations are secret.

After questions from journalists, he abstained from voting on drugs related to his compensation during a recent meeting, the Center for Public Integrity and NPR reported.

Ramadan said his clout is limited because the 16-member committee and a behavioral-health contractor provide recommendations, while Arizona Medicaid staffers make the final decisions.

MORE:  Audit: Arizona fails to collect $36.7 million in drug rebates

Federal records show most of Ramadan’s compensation came from two companies, Janssen and Otsuka. The payments were for travel, meals and speaking about schizophrenia medications, the companies reported.

The medicines are injected monthly and cost $2,000 more than daily generic pills, the Center for Public Integrity and NPR said.

Research shows the long-lasting form can be helpful for patients with mental illness who may forget to take pills regularly or stop when they start feeling better.

Maricopa County jails recently began accepting free samples of the long-lasting schizophrenia drugs from Janssen and Otsuka to inject into inmates.

County officials acknowledged it was “good business” for the pharmaceutical companies to start inmates on drugs in jail.

Otsuka did not respond to interview requests from the Center for Public Integrity and NPR.

A spokesperson for Janssen said health-care decisions should be “free from improper influence.”

“We have strict guidelines in place that ensure our interactions with health-care professionals are appropriate and compliant with all laws and regulations, and we publicly disclose all payments to physicians,” Kelsey Buckholtz told the media outlets.

Lacking transparency

Transparency is lacking at many Medicaid pharmaceutical committees, the Center for Public Integrity and NPR reported.

Speakers often testify to committees without disclosing their financial relationships to pharmaceutical companies, the investigation said.

And although Arizona’s committee applications ask if prospective members have financial ties to companies that may have business before the board, the forms do little to ensure transparency.

While Ramadan listed the drug companies that compensate him for work as a consultant and speaker, several committee members who received gifts from drug makers in the past 24 months checked a box that said they did not, according to a review by The Republic.

The disclosure forms also do not include the amounts of payments or the related medications, The Republic discovered.

The forms are not posted publicly and are not provided to members of the committee, the media outlets said.

The committee’s decision-making process is also opaque.

The Arizona pharmaceutical committee’s final discussions are held behind closed doors. And the meeting minutes do not record specific members’ votes, records show.

After The Republic’s inquiry, Ducey announced he will require the Arizona Health Care Cost Containment System to post committee members’ financial disclosure forms online and compel all people who testify to reveal whether they have financial ties to pharmaceutical companies.

The governor also will mandate the agency provide yearly conflict-of-interest training to all committees. 

Ducey left open the question of whether doctors who serve on the committee will be allowed to continue to accept any compensation from drug makers.

He ordered the agency to determine “an appropriate threshold.”


Read or Share this story: