North Carolina’s attorney general is suing drug maker Insys Therapeutics Inc., over allegations that the drug company paid kickbacks to doctors to prescribe its potent opioid Subsys to patients who didn’t meet the requirements for the medication, then lied to insurers to get them to cover the cost.
Attorney General Josh Stein’s Consumer Protection Act lawsuit is one of several against Insys and its executives, including criminal racketeering and fraud charges in Massachusetts and civil and consumer protection claims in New Jersey. The drug company and its executives, who are not named in the North Carolina suit, are accused of contributing to the nation’s growing opioid epidemic.
Subsys is a powerful painkiller spray that contains the opioid fentanyl, which is about 50 times more potent than heroin. The drug is only approved to treat breakthrough pain in patients currently on 24-hour opioid therapy. Pharmaceutical representatives from Insys allegedly provided financial incentives to doctors to prescribe the drug for other conditions, like back pain, and hosted events designed to encourage doctors to prescribe the drug to patients off-label.
Because Subsys is so lethal, insurance companies required prior authorization before approving the drug for use. Insys offered to take over this responsibility from doctors, and misrepresented itself as actually working for the providers instead of the drug company, and would lie to the insurers about what the drug was prescribed for. This resulted in the prior authorization rate jumping from 30-33 percent to 85 percent in about a year.
North Carolina estimates that only 10 percent of the patients prescribed the drug were actually eligible for it.