Did lagging profit spur fentanyl’s rise?
Prosecutors: conspiracy came amid slow sales of drug for cancer patients
PHOENIX — A new mouth spray that delivered the painkiller fentanyl to endstage cancer patients wasn’t selling as well as anticipated, so drug company executives moved quickly to make its production worthwhile.
U.S. court records in the case against one of Arizona’s wealthiest men describe the daunting market challenges that Insys Therapeutics founder John N. Kapoor and fellow executives faced after launching the opioid medication Subsys in 2012.
The highly addictive drug was going to cost a cancer patient thousands a month to control intolerable pain. It could only be prescribed by a medical practitioner registered with the Drug Enforcement Administration, and it was among several pain medicines on the market.
Five years later, Subsys is at the heart of the case against Insys Therapeutics executives, including Kapoor, a 74-yearold Phoenix man, who is charged with leading a conspiracy to bribe doctors and pharmacists to prescribe the potent painkiller to people who didn’t need it.
It comes amid an opioid epidemic that claims thousands of lives each year and led President Donald Trump to declare a U.S. public health emergency.
The case is just the latest example of how profits have become more important than health for many pharmaceutical firms, New Jersey-based health analyst Steve Brozak said Friday.
The aggressive market tactics federal prosecutors described at Insys have become acceptable, said Brozak of WWB Securities, a health care research firm that tracks companies in the sector.
“The only reason (Kapoor) was put in handcuffs and did the perp walk is because the marketing involved an opioid,” he said. “This is an example of a greater addiction, not to opioids, but to big sales. The opioid crisis is the logical extension of the earnings demand.”
To make Subsys more profitable, Insys executives turned to aggressive marketing tactics, such as bribes and kickbacks that included “speaker fees and honoraria for marketing events, food and entertainment” for doctors and pharmacists who prescribed the drug, according to a federal fraud and racketeering indictment in the case. The new charges were filed this week in Massachusetts.
In exchange, the practitioners are accused of writing large numbers of prescriptions for patients, most of whom were not diagnosed with cancer.
Prosecutors say the scam stretched across the U.S., involving pharmacies and pain management clinics and practitioners from Michigan to Texas.
Federal prosecutors in Boston first brought the case against six Insys executives and managers, including former CEO Michael L. Babich, who are set to go to trial next year and have pleaded not guilty. The updated indictment unsealed this week brings new charges against them and alleges Kapoor and the others provided kickbacks to doctors and conspired to defraud insurance providers.
The court records describe events that encouraged sales representatives to push practitioners to prescribe ever higher doses of the fentanyl spray. A video at one event purportedly showed company employees dancing, rapping and singing with a life-size bottle of the highest dosage of the spray, suggesting that increased amounts were “not a problem!”
To get paid back by insurance companies that didn’t want to fund the drug for non-cancer patients, the company established a “reimbursement centre” that used employees to suggest they were calling on behalf of a doctor and the patient in question had cancer — even if that wasn’t true, the indictment says.
Fentanyl is useful for managing pain for people with end-stage cancers, said Dr. Karen Sibert, an associate clinical professor at UCLA medical school. But opioids are dangerous when used incorrectly and without medical supervision because they can cause a person to stop breathing, she said.
“If you have extreme pain from endstage cancer, the risk from stopping breathing is an acceptable risk,” she said. “But it’s not if you are a young person with back pain.”
A judge set bail for Kapoor at $1 million and said he must wear electronic monitoring and surrender his passports.
— The Associated Press