Lawsuit: Opioid reps misled insurers, paid kickbacks to doctors

opioid oxycodone Shutterstock 329x210 Lawsuit: Opioid reps misled insurers, paid kickbacks to doctors The family of 32-year-old Sarah Fuller filed a lawsuit against Insys Therapeutics last spring claiming the company paid kickbacks to physicians to prescribe its potent opioid Subsys, a spray version of fentanyl, which allegedly led the woman’s fatal overdose. A new report indicates Fuller was a tragic victim of unscrupulous practices by the drug company.

Insys allegedly conned insurance companies into thinking the drug was for breakthrough pain in cancer patients – its only indication – so that the insurance companies would pay for the meds. The company not only misled insurance companies, the company’s representatives also falsified medical records and paid doctors to prescribe the opioid, according to a federal indictment and ongoing congressional investigation by Sen. Claire McCaskill.

Subsys is a pricey drug and most insurers wouldn’t agree to cover the cost unless prior authorization was granted. According to the complaint, to ensure patients got their Subsys, Insys reps would call insurance companies pretending to be with doctors’ offices, and insist the meds were for “breakthrough pain” without specifically saying the prescription was for breakthrough cancer pain – its only approved use.

According to the investigation, Insys reps went to such great lengths to con insurance companies that they obscured outgoing phone numbers on caller IDs so the number couldn’t be traced back to the drug reps. If an insurer needed a phone number to call the rep back, they were allegedly given a “1-800 number manned by another Insys representative – instead of contact information for the prescribing physician,” according to McCaskill’s report.

Such practices were used to ensure that Fuller received her Subsys spray to treat fibromyalgia and back pain. During her doctor’s appointment, an Insys sales representative joined Fuller and her doctor to convince Fuller that its liquid fentanyl Subsys could relieve her neck and back pain. The representative then called the woman’s insurance company, saying the prescription was for “breakthrough” pain, avoiding the use of the word “cancer.”

In December, six former Insys executives including its former CEO were slapped with criminal charges of fraud and racketeering related to the marketing of Subsys. Other federal charges have since been brought against others involved in the pushing of Subsys, and several state attorneys general have also filed lawsuits. Fuller’s family filed a wrongful death lawsuit against Insys, Fuller’s physician, the practice TLC Healthcare 2, and Linden Care, the Woodbury, New York specialty pharmacy that filled Fuller’s prescription.

Righting Injustice