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Insys execs found guilty in Subsys kickback case

  • On Thursday, a federal jury convicted five former Insys Therapeutics executives, including the company’s founder John Kapoor, for their involvement in bribing doctors to prescribe a fentanyl spray.
  • “Today’s convictions mark the first successful prosecution of top pharmaceutical executives for crimes related to the illicit marketing and prescribing of opioids,” said Andrew Lelling, U.S. Attorney for Massachusetts, in a statement.
  • Sentencing dates have yet to be determined, but the conspiracy convictions under the Racketeer Influenced and Corrupt Organizations Act can carry a sentence of up to 20 years in prison.

As the opioid crisis has worsened, U.S. legal authorities have broadened their prosecutorial ambitions.

In addition to Insys, both Purdue Pharma and the Sackler family have been under legal scrutiny for their alleged role in spreading the use of painkillers through tactics used to sell Oxycontin. 

Former execs of the Rochester Drug Co-operative, or RDC, were criminally charged on April 23 for illegally diverting opioids. While ex-CEO Laurence Doud is fighting the charges, other RDC execs have pleaded guilty and the private company reached civil and criminal settlements.

In all three instances, prosecutors have framed the cases as sending a message to the rest of the drug industry.

The FBI will “continue to identify and bring to justice corrupt individuals and companies whose business practices promote fraud with a total disregard for patient safety,” FBI special agent Joseph Bonavolonta said in a statement. 

According to the Justice Department, Insys bribed doctors to boost prescription rates for Subsys, the company’s fentanyl-based painkiller. Subsys is indicated for cancer patients with intense breakthrough pain, but company execs focused on expanding into non-cancer patients as well.

The execs used pharmacy data to target high-volume prescribers, and also sought to boost the dosage and number of Subsys units along with raising the number of new prescriptions.

Practitioners who took bribes but failed to prescribe enough of the painkiller saw their kickbacks reduced or eliminated. The company’s execs deemed bribes worthy only if doctors generated net revenue at least twice the amount of the bribe, according to the DOJ. 

The actual payout method varied. One such way was through a speaker program, launched in 2012, that used lunches and dinners as a vehicle to pay doctors, the DOJ said. 

The company also launched the Insys Reimbursement Center to help secure health insurance payments for Subsys, particularly when prescribed to non-cancer patients. Employees at that center relied on a script to mislead insurers on the patients’ diagnoses.

“In most instances, the programs were shams,” the Justice Department stated.