Disturbing and Unscrupulous Opioid Sales Tactics Continuing To Emerge from Insys

In a staggering and sickening case against the founder of Insys Therapeutics Inc., the details of the methods used by Insys to boost the sales of their powerful opioid, Subsys, just keep getting more appalling. The company is on trial for racketeering and using their money and influence to entice doctors into prescribing the drug to those who weren’t medically eligible to be taking it.

Insys Therapeutics Inc. is a pharmaceutical company based in Chandler, AZ. Its founder and former CEO, John Kapoor, was arrested in late 2017 on charges of RICO conspiracy, conspiracy to commit wire fraud, and conspiracy to violate the Anti-Kickback Law, which prohibits the exchange or offers to exchange anything of value in return for the referral of federal health care program business.

Subsys is an oral spray used as a painkiller for cancer patients who are already demonstrably tolerant of opioids. Its active ingredient is fentanyl, a potent and highly addictive substance that is largely fueling the opioid epidemic that is ravaging communities all over the country. Subsys is only meant to be used to treat occurrences of breakthrough pain, which happens when a patient’s regular, round-the-clock pain medicine wears off before the next expected dose. An active cancer diagnosis is required for the prescription of this medicine.

However, in the case of Insys, investigators found that only 10% of patients who were prescribed Subsys actually had an active cancer diagnosis. In the case of just one death linked to the drug, the patient, Sarah Fuller, was suffering from fibromyalgia and back pain, and did not have cancer, but was given the medication anyway. Her prescribing doctor was found to have received $600 in payments from Insys in 2015. She also would have had to be deemed eligible for the medication by the pharmacy benefits manager Envision.

They were found to have been misleading insurers to believe that more patients needed Subsys than actually did. The company frequently had employees pose as representatives from doctor’s offices calling on the behalf of patients in order to boost sales, fabricating patients’ medical histories and falsely claiming cancer diagnoses. Employees were given quotas and offered bonuses in this pursuit.

In the case of Sarah Fuller, Envision was contacted by an Insys representative on her behalf, claiming to be with Fuller’s doctor’s office and manipulating the conversation to claim that Fuller was suffering from the qualifying breakthrough pain while avoiding directly stating that she had cancer. Fuller was then approved for Subsys, which lead to her death.

Other shady sales tactics have been used, including a rap video that was played in court recently for the jurors of the case. In this video, the intent is clear: extolling the virtues of Subsys and the company, while encouraging doctors to use a process called titration to quickly increase Subsys users’ doses to the highest amount possible for the patient. The video features the company’s former VP of sales, Alec Burlakoff, dressed as a prescription bottle of the spray, which is labeled as “Subsys 1600 MCG”, the highest dose available. Prescriptions of the maximum dose came with a bonus of $1,830 for the prescribing doctor, which also helped the company show higher sales for their first IPO in 2013.

These sales tactics included other kickbacks for the doctors, such as Insys paying for fancy dinners, travel expenses, and compensation for sham speaking events. The trial against Kapoor, which has included weeks testimony from former company executives, is expected to continue for several more weeks. Numerous medical practitioners have so far been charged or plead guilty to accepting these kickbacks in exchange for prescribing Subsys to patients who did not meet the requirements to take the medicine. Many of the practitioners who have been involved in opioid overprescription cases are still practicing medicine today.