Why the First Lady’s Involvement With a Big Pharmaceutical Company Is Noteworthy

Half a dozen pharma lobbyists say they were were amazed—and envious—at the access Johnson & Johnson got.

Aimee Wilson Kotek (Oregon.gov)

On April 3, representatives of the pharmaceutical company Johnson & Johnson met with the state’s director of behavioral health, Ebony Clarke. Emails WW first revealed last week show that the unusual meeting was brokered by Oregon first lady Aimee Kotek Wilson.

In interviews with WW, six Salem pharmaceutical lobbyists expressed surprise that Johnson & Johnson reps could obtain a meeting with the governor’s wife and that she would then arrange a meeting for the drug manufacturer with the Oregon Health Authority’s top mental health official.

Both steps in that sequence, lobbyists say, fall outside of Salem norms.

“Generally, pharmaceutical companies have a challenging pathway to the governor’s office for a variety of reasons,” says a lobbyist who represents one of them. “It would be incredibly meaningful to my client to get meetings like Johnson & Johnson did.”

Johnson & Johnson, with 2023 revenues of $85 billion, is the nation’s second-biggest drug company. After reporting on the meetings online May 16, WW spoke with a host of lobbyists who have represented other large pharma companies.

“In my experience, that’s something you’d never be able to do,” one of the lobbyists said. “It would absolutely be beneficial to a client. They’d love it.”

As for Kotek Wilson emailing Ebony Clarke, the director of behavioral health—and copying Gov. Tina Kotek on the email, as Kotek Wilson did earlier this year—a third veteran lobbyist expressed amazement.

“It’s a little bit stunning that they [Johnson & Johnson] were able to get to the first lady,” the lobbyist says. “And it’s highly unusual to have the governor’s office emailing the OHA to meet with a pharmaceutical company.”

Another pharmaceutical lobbyist said his pharma clients would “covet” the opportunity to meet with Kotek Wilson, whose unusual involvement in policy decisions in her wife’s office triggered five high-level departures from the Kotek administration (“Co-Governors,” WW, May 15). There are a couple of reasons why such access is valuable.

First, the pharmaceutical market is enormous: According to state figures, the Oregon Health Plan paid nearly $1.4 billion for prescription drugs last year. It’s a competitive marketplace, and although Oregon strives to be objective about buying the most effective and competitively priced drugs, lobbyists say the process remains intensely political. In other words, having friends in the governor’s office could be influential.

Second, the governor’s staff has a rigorous process for vetting access to the governor and her top staff advisers. Emails show that when a request for a meeting or even a phone call comes in, there’s a detailed evaluation process and often a formal memo: Who wants the meeting? For what purpose? What are the potential risks and benefits? Which staff should attend? And emails show Kotek’s staff rejects many meeting requests for every one it accepts.

For the first lady, however, there was no such process. As the senior staffers who left the office noted, she does what she wants without the accountability required of other Kotek advisers.

At a May 1 press conference, Kotek downplayed her wife’s role in her office. “You can see from her calendar, she has not been meeting with staff since the first of the year.”

But the Johnson & Johnson emails show she’s been involved at a high level—with significant public dollars potentially at stake.

On April 1, New Brunswick, N.J.-based Johnson & Johnson suffered a setback in the U.S. Court of Appeals for the Federal Circuit, which rules on patent disputes.

Two smaller drug company rivals, Teva and Mylan, had challenged Johnson & Johnson’s patent on Invega Sustenna, a long-acting, injectable medication for treating schizophrenia.

Reuters said the appellate decision threatened Johnson & Johnson’s “blockbuster” schizophrenia drugs, “giving [Teva and Mylan] a new chance to clear a path to launch cheaper generic versions of the medicine.”

Johnson & Johnson has gone to federal court repeatedly to protect patents on its Invega Sustenna and Invega Trinza brand injectables, which generated sales of nearly $2.9 billion in 2023. Those are the drugs that emails show the two Johnson & Johnson employees who met with Kotek Wilson represent.

The drugs have a big footprint in Oregon, records show. A summary of spending for the fourth quarter of 2023 shows that the Oregon Health Plan spent more on Johnson & Johnson’s Invega Sustenna than any other drug for fee-for-service patients. The three Johnson & Johnson schizophrenia injectables accounted for 15% of OHA’s spending on the top 40 drugs ranked by gross amount paid for fee-for-service patients.

Kotek Wilson’s calendar shows she first met with the drug company representatives Aug. 15, 2023.

Following that meeting, Leslie Fox, who works for Johnson & Johnson’s Strategic Customer Group, followed up with Kotek Wilson. (Fox’s LinkedIn profile says her role is “impacting sales, enhancing market position and impacting health policy with providers, patient and disease advocacy groups.”)

“Sophia [Yu, another Johnson & Johnson official] and I would like to thank you for meeting with us last Friday. We appreciate you sharing your passion for those with serious mental illness and how long-acting injectables are part of the solution,” Fox wrote. “You expressed an interest in having Sophia share this data with others within the State, including the Behavioral Health Advisor and the Behavioral Health Director who will both be starting in early September,” Fox wrote. “Please let us know when those opportunities would be best suited.” (Fox, Yu and Johnson & Johnson didn’t respond to requests for comment.)

Fox was alluding to Juliana Wallace, Kotek’s newly hired behavioral health adviser, and Oregon Health Authority behavioral health director Ebony Clarke, who moved to the state agency from Multnomah County last year.

On Sept. 5, Kotek Wilson forwarded Fox’s email to Clarke, Wallace, and Kotek’s health care adviser, Kristina Narayan: “I wanted to share this email with you between the three of your positions, you should be able to access this information. It was very interesting. We can talk more about it.”

The conversation then went quiet.

On Nov. 6, records show, Johnson & Johnson made a $5,000 contribution to Gov. Kotek’s political action committee. That amount was twice Johnson & Johnson’s largest previous contribution to an Oregon politician, $2,500 to Gov. Kate Brown in 2017.

Kotek campaign spokesman Thomas Wheatley says the contribution was routine. “The contribution from Johnson & Johnson was part of a fall 2023 fundraising event,” Wheatley says. He adds that he didn’t know anything about the meeting Kotek Wilson held with J&J representatives.

On Feb. 5, 2024, Fox emailed Kotek Wilson again. “I wanted to check in and follow up on our discussion from last summer,” she wrote. “I know that we were waiting for the new behavioral health director and team at OHA to start their roles in early fall. Look forward to a continued discussion.”

Kotek Wilson forwarded the message to Clarke and Wallace, this time with a notable change: She copied her wife, the governor, on the email.

“Leslie Fox is a contact from Robin Henderson who I spoke with in August of 2023, she has some interesting data to share,” Kotek Wilson wrote. “She reached back out to me today.”

(As WW reported earlier, Henderson, the CEO of behavioral health at Providence Health & Services Oregon, appears regularly on Kotek Wilson’s calendar. The first lady has said Henderson helped prepare her for speaking engagements. Providence also has significant policy and financial issues before the state.)

Wallace and Clarke responded immediately to Kotek Wilson, both copying the governor on the email. “Thank you for reaching out,” Clarke wrote. “I am very curious about this data set. A zoom call sounds like a good first step.”

The result was that Clarke met with the Johnson & Johnson officials representing its patented schizophrenia medications April 3, two days after the federal appeals court opened a pathway for competitors to sell cheaper generics (the first lady bowed out at the last minute).

After the meeting, Fox followed up with an email, copying the first lady.

In that email, Fox referred to studies that showed the benefits of giving patients long-acting injectables, i.e., the product her company sells, sooner in their treatment. “I am also attaching the work that the Mental Health Clinical Advisory Group did to provide guidance for clients with schizophrenia,” Fox wrote. “This is the work where they look to move LAIs [long-acting injectables] to an earlier use for those diagnosed with schizophrenia.”

Kotek responded to questions about the first lady’s interactions with the drug company representatives with a statement:

“In preparation for the September 2023 roundtable focused on the intersection of serious mental illness (SMI) and homelessness, the Governor’s Office was connected with [Johnson & Johnson] to get a better understanding of the consumer data they might be able to share in order to understand the breadth of the SMI population in Oregon.

“J&J, like other pharmaceutical companies, is uniquely able to provide consumer data related to the use of certain drugs, such as long-acting injectables, among the SMI population broadly. No specific J&J product was discussed, but rather the potential sharing of data related to this vulnerable population. In the months following, J&J followed up by email and the First Lady appropriately handed off the discussion to the Oregon Health Authority.

“The first lady gained the information she needed to inform the discussion at the SMI roundtable, then handed off all subsequent inquiries to the appropriate agency and staff, and copied the governor for full transparency.”

An OHA spokesman, Timothy Heider, says Clarke’s April 3 meeting was simply an opportunity to share information.

“Oregon continues to face an acute shortage in care that will take several years to close. State health officials want to explore every opportunity to improve treatment access and treatment outcomes,” Heider said. “OHA’s behavioral health director, Ebony Clarke, and members of her staff met with Johnson & Johnson representatives to learn about their diagnostic tool and injectable treatment medication. No follow-up meetings have been scheduled.”

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