Pharmaceutical companies’ aggressive marketing of expensive (and profitable) medications has likely exacerbated America’s problems with health care.

The tactics some have used in convincing doctors to write more prescriptions are questionable.

It’s a difficult number to quantify, but there’s no doubt that unnecessary prescriptions of expensive medications have cost taxpayers a significant amount through Medicare and Medicaid patient billings.

Most of these issues have fallen into a gray area of the law and medical ethics, and haven’t, frankly, been seen as a pressing enough public policy issue to prompt significant reform.

The case of Heather Alfonso should change that in Connecticut and beyond.

As chronicled in some excellent reporting by the Connecticut Health Investigative Team’s Lisa Chedekel, Alfonso recently showed up as the top Medicare-billable prescriber in Connecticut of Schedule II narcotics. She was also on a list of the top 10 highest prescribers in the country of a drug called Subsys. It’s a pain killer intended for cancer patients that includes the opioid Fentanyl.

Opioid overdoses killed at least 307 people in Connecticut last year, and 257 the year before. Experts have identified a pattern of patients getting hooked on prescription painkillers and then switching to a cheaper substitute — heroin. Sports Illustrated recently wrote about how the problem is spreading even to high school athletes who get prescriptions to deal with sports injuries.

Alfonso, who worked at the Comprehensive Pain and Headache Treatment Center in Derby, pleaded guilty Tuesday to accepting $83,000 in kickbacks from January 2013 to March 2015 in exchange for pushing Subsys. According to Chedekel’s reporting, Alfonso was prescribing it to non-cancer patients who complained of chronic pain, and wrote “about $1.6 million in prescriptions” for it over the course of two years.

Considering the likely profit margins on a drug such as Subsys, that’s a pretty good return on investment for Insys Therapeutics, the Arizona company that makes the drug.

It paid Alfonso for “more than 70 ‘dinner programs,’ at a rate of approximately $1,000 per event.” This is a common thing between drug companies and physicians. They are paid as consultants, speakers at conferences, and so on. Except, according to Chedekel, Alfonso and a drug company rep were often the only people in attendance at these “dinner programs,” and she never really gave any kind of speech or presentation or consultation about the drug.

Alfonso is in trouble for defrauding the taxpayer-funded Medicare and Medicaid programs — pushing prescriptions not because they were the best medical option but because she was getting kickbacks from a drug company.

Connecticut and other communities across the country struggling with opioid abuse should consider far more serious charges against medical professionals who do this and drug companies such as Insys who “influence” them.

It’s not about Medicare fraud or bloated health care costs anymore. It’s greed leading to the death of our friends and neighbors.

Matt DeRienzo is a media industry consultant who lives in Litchfield. He is the former editor of Digital First Media’s publications in Connecticut, including the New Haven Register, Register Citizen of Torrington, Middletown Press and Connecticut Magazine.

DISCLAIMER: The views, opinions, positions, or strategies expressed by the author are theirs alone, and do not necessarily reflect the views, opinions, or positions of

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Matt DeRienzo

Matt DeRienzo is the editor of the Center for Public Integrity.

The views, opinions, positions, or strategies expressed by the author are theirs alone, and do not necessarily reflect the views, opinions, or positions of or any of the author's other employers.