This article was published in partnership with The Marshall Project, a nonprofit news organization covering the U.S. criminal justice system.
Using certain kinds of drugs can land you in lockup, but pharmaceutical giant Johnson & Johnson is selling a drug that it now claims can keep you out.
Last month, the company announced it got the green light from the FDA to promote an unusual benefit of Invega Sustenna, an antipsychotic medication administered to patients as an injection once a month: The medication, the FDA concluded, could potentially keep people with schizophrenia out of prison or jail.
The decision was based on a study sponsored by Janssen Pharmaceuticals, a J&J subsidiary. In the study, schizophrenia patients who received the monthly injection ended up behind bars less often than people who took a daily pill to control psychotic symptoms.
Schizophrenia, often characterized by hallucinations, delusions and a break with reality, is a particularly debilitating illness. “This is really the only illness in United States that one of the major side effects...is jail time,” said John Snook, executive director of the Treatment Advocacy Center, a national group that advocates for the severely mentally ill.
The study didn’t reveal anything particularly magical about Invega Sustenna, only that people are able to stay on it longer—one dose lasts 30 days—delaying the onset of the behavior that can send them to the hospital or jail. Once a patient finds a drug that works, said Dr. Frederick Nucifora, Jr. of Johns Hopkins School of Medicine, “it really comes down to staying on medicine.”
The study did not compare Invega Sustenna to other injectable, longlasting antipsychotic drugs.
Invega Sustenna was first approved by the FDA in 2009, and this latest move by the agency comes with a big perk: it allows J&J another three years of market exclusivity for the drug, delaying generic competitors.
Invega Sustenna, and its sister drug, Invega Trinza, which patients take every three months, are lucrative, bringing in $2.2 billion for the company in 2016. But they still face challenges. It’s not the only injectable out there, and “America tends to be a pill oriented marketplace,” said Gary Branning, an adjunct professor who teaches in the pharmaceutical management program at Rutgers Business School Newark and New Brunswick.
A single injection of Invega Sustenna can cost anywhere from $400 to more than $2,000, depending on dosage, according to Medicaid data.
Medicare and Medicaid cover Invega Sustenna, but patients often need prior authorization before either program will pay for it. A patient has to show that he or she has tried other medications, such as one of the dozens of generic antipsychotic pills available, and none of them worked.
Psychiatric medication, and antipsychotics especially, are notorious for significant and uncomfortable side effects, leading many people to stop taking them.
“The medications themselves can be really hard for a lot of people, but the alternative is sometimes even worse,” Snook said. “It’s a hard decision.”
Branning said the new information helps J&J convince insurance companies that the drug is worth the higher price. Incarceration is expensive, as are hospital stays, so why not use something that can decrease the frequency of both?
A spokesman for Janssen declined to comment on the company’s marketing strategies.
Using jail time as a selling point is a “depressing commentary” on the state of mental health treatment in the U.S., Snook said. Though having schizophrenia doesn’t guarantee coming in contact with law enforcement, there is a heightened risk, said Snook. “[It] is a reality for every family who has a loved one with schizophrenia.”
The study followed 444 adults with schizophrenia who had been arrested at least twice in the last two years, with at least one of those arrests leading to incarceration. People given the Invega Sustenna injection went significantly longer without an arrest than their counterparts on the daily pill form of other common antipsychotic medications. And for those on the injection that relapsed, fewer went to jail or were hospitalized than those on the pills.