Washington, DC Federal investigators have revealed a massive scheme by Insys, maker of Subsys, a sprayable form of fentanyl, to mislead insurers and boost sales of the opioid. The congressional investigation is led by Sen. Claire McCaskill, a Democrat from Missouri, where deaths by opioid overdose have more than doubled between 2005 and 2014.
The allegations state that due to the high cost associated with Subsys, most insurers wouldn't pay for it unless it was approved in advance, a process called "prior-authorization." However, Insys realized shortly after the opioid pain medication was approved, that there weren’t enough cancer patients to make the drug commercially viable.
The Senate report documents an elaborate plan to fool insurers into paying for Subsys prescriptions. Specifically, the report shows that beginning in 2014, Insys employees would set themselves up so that it appeared as if they were working for doctors, thereby being in a position to request the prescription. When someone needed to obtain prior approval for a Subsys prescription, it was actually an Insys employee who called the insurer and its affiliates to persuade them to approve the prescription. Believing they were speaking with people who worked for the doctors requesting the prescription, the insurers would issue an approval.
The report cites recorded calls which show that Insys employees had a carefully crafted script designed to intentionally leave that impression. Further, Insys hid its outgoing phone number on caller IDs, so that calls wouldn't be traced back to the company, the report said. And if an insurer needed a phone number for a return call, company employees "reportedly provided a 1-800 number manned by another Insys representative -- instead of contact information for the prescribing physician," according to McCaskill's report. (CNN.com)
In December 2016, six former Insys executives, including its former CEO, were criminally charged with fraud and racketeering related to Subsys. Federal prosecutors described a "nationwide conspiracy to bribe medical practitioners to unnecessarily prescribe a fentanyl-based pain medication and defraud health care insurers." CNN.com
According to McCaskill’s report, provisional statistics from the Centers for Disease Control on the opioid epidemic show “drug deaths from fentanyl more than doubled from 2015 to 2016 and deaths involving synthetic opioids, mostly fentanyls, has risen to more than 20,000 from 3,000 in just three years.”
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