As per the released report by Claire McCaskill, a Democratic Senator from Missouri on Wednesday, in order to boost the sale of the company, Insys Therapeutics Inc allegedly sold an ultra-powerful opioid drug named Subsys meant for cancer patients by allegedly taking patients who did not have cancer and made it look like they did.
The ongoing investigation by McCaskill also showed that combinations of different tactics were used by the company that included false medical records, misleading statements to get insurance cover.
Besides, as per the Senate report, due to the high cost of Subsys, most of the insurers would have to take ‘prior-authorization’ in order to pay for the drug. Thus, to fool the insurance companies to approve the drug, the company’s employees who were actively engaged with the company would act as gatekeepers at the pharmacy and pretended like they were involved with the doctor’s office so that they could provide Subsys to those patients who did not have cancer.
The report also cited a case of Sarah Fuller of New Jersey, who did not have cancer but unfortunately died in March 2016 due to Subsys overdose. She was prescribed Subsys by her doctor.
An audio recording mentioned in the Senate report also showed how an Insys employee called a pharmacy benefit manager to persuade him to get the approval for Fuller’s prescription. He was under the impression that he was talking to someone who was working for the patient’s doctor which led to fooling him in getting the approval for the drug.
A properly drafted script was used by the company to persuade the insurer.
So that no one could trace the call made, the company even obscured the outgoing phone number on caller IDs. The plan was organized and executed to perfection.
Now, Insys is currently in the midst of criminal and civil legal trouble.
However, based on the various state and federal investigations, Insys was not likely the only company engaged in such activity. The investigators are now looking into how this illegal drug supply was a top-down disaster.