Aristada, a relative newcomer in the antipsychotic-injection sector, trails behind Invega Sustenna and Abilify Maintena. As Alkermes seeks to catch up, it has provided the treatment in 40 correctional facilities in 18 states, offering free samples to many of them. And it has paid doctors to speak at criminal-justice conferences about its potential, as well as designing advertisements that depict people reentering society thanks to the shot. Two doctors told me Alkermes paid them to participate in focus-group panels where they were asked by company representatives about how to market the shot to criminal-justice officials.
Mogilner, the Alkermes spokesman, did not answer specific questions about the company’s marketing and sales tactics but noted that they are, to a large degree, no different from other companies’ efforts. He wrote in an email that Aristada can offer people leaving prison or jail “consistent and sustained” treatment during “the often-challenging transition back to the community.”
Corrections officials don’t have to exclusively prescribe Aristada in exchange for free samples, Mogilner added, or continue prescribing the shot after the samples run out. “We work to educate healthcare professionals and other stakeholders with whom they work about the treatment of schizophrenia in diverse settings of care, including criminal justice healthcare settings, community mental health centers, and hospitals,” he wrote. “No one medicine is right for every patient.”
Several health-care officials and practitioners told me that free samples of long-acting antipsychotic shots have helped their patients in the criminal-justice system access helpful drugs that would otherwise be too expensive for them to offer. “Funding is always an issue,” Rachel Waddell, a nurse practitioner who treats inmates in a 662-bed jail in Rapid City, South Dakota, told me. The jail has provided samples of Aristada to 10 inmates but hasn’t accepted payments from drug companies, or perks such as free lunches. “With Alkermes, we don’t have to jump through hoops.”
Officials in Maricopa County, Arizona, have not taken perks or payments from drug companies, but they have accepted free samples of long-acting shots from Janssen, Otsuka, and Alkermes. Grant Phillips, the medical director of Maricopa County’s correctional-health services, said that nearly 120 inmates are on long-acting shots and that they work well. More than half of those are ordered by judges, he said, but judges leave it up to doctors to decide which product is best for their patients. The medication consumes a fifth of the total pharmacy budget for a jail population of about 7,500.
While some jail officials see mostly an upside in drug companies’ marketing efforts, others say it’s more complicated. Jeff Gromer, the former warden of the Minnehaha County Jail in Sioux Falls, South Dakota, said he hasn’t accepted perks or consulting payments, but he has given samples of Aristada to 16 patients since 2018; their symptoms stabilized while on the drug. “When you put someone with anxiety and paranoia in [a jail] environment, it gets hard for them to cope,” Gromer said. “When they can’t cope, there’s behavioral problems such as self-harm or aggression toward inmates or staff, or hiding in their cell.” Still, he’s wary of Alkermes’s efforts to reach patients by marketing to criminal-justice officials overseeing them. “Alkermes’s hope is that the prescription is continued once they’re out of custody, and they’re going to get paid for that,” he said. (Alkermes didn’t comment on Gromer’s characterization.)