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[Update: Utah governor says the state will not make planned purchase of malaria drugs for COVID-19 patients]
In a rush to make up for testing lags early in the coronavirus pandemic, at least three states, including Utah, have enlisted the Orem company Nomi Health to run statewide websites to screen patients and offer thousands of diagnostic tests.
The team that launched TestUtah.com has also won multimillion-dollar, no-bid contracts in Iowa and Nebraska, and the screening form for testing in all three states asks about users’ symptoms and social distancing practices. But the questionnaire also has asked whether patients are allergic to hydroxychloroquine — the malaria drug that’s been controversially touted by President Donald Trump as a “miracle” treatment for COVID-19.
And in Utah, Mark Newman, the founder and CEO of Nomi, also serves on the board of directors of the pharmacy that had already has won an $800,000 state contract for 20,000 doses, according to federal documents obtained by The Salt Lake Tribune.
Newman on Thursday argued the dual roles — leading a company that is identifying potential patients and helping to steer Meds in Motion, a supplier of the debated treatment — don’t pose a conflict of interest.
Even if the drug proves effective against COVID-19 and the statewide data-collection websites he’s running facilitate its use, he said, patients won’t necessarily buy their doses from Meds in Motion.
“They should just go to Walmart or CVS or whatever and pick up their prescription,” he said.
But Meds in Motion could be the supplier for most of those stores. State health officials this week confirmed plans to buy a stockpile of hydroxychloroquine from the Draper pharmacy company, whose owner, Dan Richards, has for weeks been promoting the drug to state officials.
Utah lawmakers on Thursday were eyeing spending $8 million for the drug, two days after a study showed no benefits and even possible health risks to coronavirus patients who receive hydroxychloroquine.
Those plans were discarded Friday after the U.S. Food and Drug Administration cautioned against administering the unproven medication for coronavirus to patients outside a hospital or clinical trial. Gov. Gary Herbert said the state would not add to its stockpile, and he raised the idea of trying to get its money back for the 20,000 doses Utah already agreed to buy.
Herbert also said TestUtah.com would no longer screen respondents for hydroxychloroquine suitability.
The origin and timing of the hydroxychloroquine-related questions on TestUtah.com is not immediately clear. Newman said the Utah Department of Health wanted questions about hydroxychloroquine in case the drug was found to be effective against COVID-19. That would give the state information on who might be candidates to try the medication, Newman said.
But UDOH officials say they don’t know the origin of those questions. Asked again Friday, spokesman Tom Hudachko said it was “possible they were on the survey from the beginning,” but added he was having a difficult time confirming that.
Clint Betts, executive director of the nonprofit Silicon Slopes consortium of Utah tech businesses, said a Utah company called SafeLane Health helped develop TestUtah.com. He said the hydroxychloroquine questions were on the website when it launched near the start of April. Representatives of SafeLane did not return a message seeking comment Friday afternoon.
Newman and Betts asserted that all questions on TestUtah.com have been inserted at the direction of the Utah Department of Health, but UDOH officials declined to comment on the hydroxychloroquine items.
Meanwhile, the Governor’s Office of Management and Budget, which issued contracts to the vendors connected with TestUtah.com, said the questions were included “at some point” among questions about “conditions that could potentially impact how severely an individual might be impacted by a COVID-19 infection.”
Most of the conditions listed among the TestUtah.com hydroxychloroquine questions were not identified by the Centers for Disease Control and Prevention as risk factors for COVID-19, but all have been linked to negative outcomes with hydroxychloroquine. The FDA on Friday issued a warning against using the drug for coronavirus outside of hospitals or clinical trials because of possible health risks.
The Utah Department of Health on Thursday had said it was “still researching FDA requirements” and had not bought the 200,000 doses of hydroxychloroquine it previously anticipated. Instead, a different state office had committed $800,000 to buy 20,000 doses from Meds in Motion. But on Friday, Herbert said state officials will not be buying any more malaria drugs.
A 2018 filing with the U.S. Securities and Exchange Commission identifies Newman as a member of Meds in Motion’s board of directors, a position he confirmed in an interview with The Tribune.
Newman is better known in connection to Nomi, which in March received a $5 million contract to run the coronavirus testing system TestUtah.com along with other companies connected to Silicon Slopes. The website offers a questionnaire about the user’s health and then directs selected patients to sites for testing.
This week, Nomi finalized a $26 million contract to operate a similar system in Iowa and a $27 million contract with Nebraska. In all three states, Nomi received the contracts without a bid process.
On Thursday, all three states’ websites appeared to use the same questionnaire — which included a page of information that appeared to be designed to ascertain whether the patient was a possible candidate for hydroxychloroquine.
In addition to responses such as “I have a Chloroquine allergy” and “I have a Hydroxychloroquine allergy,” the page also listed options that seemingly have little specific connection to coronavirus but are known to interact with hydroxychloroquine.
Patients may choose, for example: “I have recent Hearing Loss,” “I have Myasthenia Gravis” or “I have a Glucose-6-Phosphate Dehydrogenase Deficiency."
In its contract with Iowa, Nomi also recommends as an “optional” step in the state’s response: “medication treatment (e.g. Hydroxychloroquine or Chloroquine) administered by the Health Department in order to keep hospital bed load low.”
Newman said the “option” was an oversight that should not have been put in the contract. Future contracts with new states will not discuss hydroxychloroquine and will instead have more generic language saying states can tailor their surveys to screen for possible COVID-19 treatments, Newman said.
“I feel like it’s become too politicized,” Newman said of hydroxychloroquine.
In Utah, before Herbert changed course, Utah health department director Jeff Burton said the state would require “a lot more information to come in that would cause us to not want to proceed” with the hydroxychloroquine purchase.
Herbert installed Burton, a retired Utah National Guard general, as temporary director of the Utah Department of Health to oversee the state’s response to the coronavirus. Burton, a Salem Republican who has filed to run for a state House seat in November, acknowledged that the drug “has not been particularly proven for treatment for COVID-19.”
“But as a state, obviously, we want to make sure we’re not late to have what our citizens need," Burton said in a Wednesday interview.
The website and the tests were initially promoted by Silicon Slopes as a philanthropic crisis response. But the Governor’s Office of Management and Budget later lined up contracts with Nomi, a health care software and data company, and software developers Domo and Qualtrics.
News of the profitable contracts prompted some criticism of the initiative on social media; on Wednesday night, Betts, the Silicon Slopes executive director, responded that TestUtah.com became too extensive to operate solely on a volunteer basis.
As of Thursday, TestUtah.com had administered 15,119 tests and 94,205 questionnaires according to the Silicon Slopes organization.
“While TestUtah started as a 100% volunteer effort," Betts wrote, “it quickly became clear that it was turning into something bigger and the state approached certain companies involved to formalize the partnership.”
But asked on Thursday whether Newman’s position at Meds in Motion could create the perception of a profit motive behind TestUtah.com, especially in light of the new survey questions, Betts said he was unaware of Newman’s ties to the pharmacy.
He also said Silicon Slopes never intended TestUtah.com to be used to identify patients for hydroxychloroquine prescriptions and firmly disavowed any ties to the drug.
“Let me be clear in this: Silicon Slopes has no involvement with the state of Utah in recommending hydroxychloroquine, and in fact has brought onto [town halls and podcasts] experts who have recommended the exact opposite," he said.
“As the executive and CEO, we would never get involved with bringing hydroxychloroquine to the state of Utah, given what experts are telling us: ... that it’s unproven, and it makes no sense to involve hydroxychloroquine in the supplies that are brought into the state."
Newman noted that Meds in Motion stands to benefit should there be more runs on hydroxychloroquine but no more so than other pharmacies do — and he said he believes the company deserves credit for keeping prices low. Meds in Motion agreed with the state of Utah on a price of about $40 per hydroxychloroquine package, Newman said.
Then, after Trump promoted the drug as a COVID-19 treatment, hydroxychloroquine increased to about $525 per package, Newman said. Yet Meds In Motion didn’t try to raise the price on Utah.
“This was meant to be more of a safety net approach for the state,” Newman said, “in case [the drug was deemed effective] and all of it disappeared.”
Editor’s note • Clint Betts serves on The Salt Lake Tribune’s nonprofit board of directors.