Summary: A pain drug producer of an opioid drug used to alleviate acute pain from cancer was making up information in order to sell more of the high-cost drug.
Cancer is something everyone is affected by and desperately wants a cure for. For a company to take advantage of this teeters on completely despicable. Insys Therapeutics is accused of creating fake cancer patients in order to sell their powerful opioid drug. The drug could treat the pain cancer patients experienced but the company was having trouble finding enough patients with cancer to buy the drug.
The company decided in 2012 that they could boost sales by making the patients look like they had cancer. They accomplished this through a combination of falsifying medical records, providing kickbacks to doctors in cahoots with the company, and misleading insurance companies, according to the federal indictment.
Missouri Sen. Claire McCaskill is leading a congressional investigation into the matter. The latest report from her office alleges how far the company went to get prescriptions of their sprayable form of fentanyl, Subsys. Since the drug has a high cost and insurers won’t pay for it without advanced approval, called “prior-authorization,” Insys had to find a way around this. They set up a process where employees pretended to be patients at the doctors’ offices so they could trick the insurance companies into approving the drug.
Insys responded with a statement: “The report relates to activities of former employees of our company and matters that the company has addressed in its own efforts and in connection with investigations by the Department of Justice and state attorney general offices. The strengthening of our compliance program has been a significant focus for more than four years.” They added that have “invested significant resources in establishing an effective compliance program.”
These changes involve how patients would obtain a prescription and approval from their insurance. Before 2014, a patient would contact the drug company to get the Subsys prescription. An employee would then call the insurer and its affiliates to persuade them into approving the payment for the prescription. The insurance companies were under the impression they were talking with someone at the doctor’s office based on a carefully written script that the Insys employees read from. The drug company even disguised their outgoing phone number from caller IDs so the phone calls couldn’t be traced back to them.
Generally, insurance companies require a return call phone number so Insys had a 1-800 number ready with another coworker answering those calls instead of a phone number to the prescribing physician. The purpose of the return calls was to determine if the patient had developed “breakthrough pain,” an acute pain caused by cancer. The requirement to obtain the prescription was cancer.
The report from McCaskill’s office claims Insys got around this requirement by carefully delivering the message to the insurer that the patient did have cancer without explicitly saying they did. The senator’s investigators were able to obtain a recording of one of those calls.
The matter came to light after a woman from New Jersey was prescribed Subsys by her doctor even though she did not have cancer. The woman died about in 2016 from a Subsys overdose. State authorities wanted the doctor’s license to be temporarily suspended. The call obtained demonstrations the language the Insys employee used when on the phone with the insurance company, starting with a statement that they were “from the doctor’s office.”
Insys president and CEO Saeed Motahari sent a letter to the investigators about the current situation. He explained that they have “completely transformed its employee base over the last several years” and have “actively taken the appropriate steps to place ethical standards of conduct and patient interests at the heart of our business decisions.”
Six former Insys executives, including the former CEO, were charged in December with fraud and racketeering for what prosecutors’ claim was a “nationwide conspiracy to bribe medical practitioners to unnecessarily prescribe a fentanyl-based pain medication and defraud health care insurers.” The six executives have pled not guilty to the charges but other former employees have made guilty pleas.
Who do you trust more – doctors, drug companies, or health insurance companies? Tell us in the comments below.
To learn more about drug companies, read these articles:
- Big Pharma, Biotech Companies Ask for Patent Protections
- U.S. Supreme Court Hearings on Drug Company Settlements
- Doctors Earn Billions from Drug Companies
Photo: azcentral.com