As opioid crisis raged, Insys pushed higher doses of addictive drug and pushed salespeople to ‘own’ doctors

Published: Oct 19, 2018 7:19 a.m. ET

Concerning sales tactics involving a potent opioid medication were highlighted in a new Senate committee report

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Family members of those who died of opioid overdoses take part in a rally to end the opioid epidemic in Washington, D.C., in 2016.

To sell addictive opioids, sales representatives were encouraged to “own” doctors, keeping a close eye on how and how much they prescribe.

Speaker programs that helped drive sales left out safety problems and, in one instance, didn’t say that Insys, the drug’s manufacturer, was sponsoring the event.

And high dosages of the addictive opioid Subsys were linked to bonus payments, with company presentations encouraging this behavior through slogans like “Strength Makes the Difference” and “Don’t Forget the Doses.”

“It is much easier to take an existing patient and double their units (which in essence is the same as generating a new prescription),” one sales manager wrote, referring to patients as “low hanging fruit.”

Those tactics and more were hallmarks of drugmaker Insys Therapeutics Inc.’s INSY, -2.20%  approach at the height of the opioid crisis, according to a new report from the Senate Homeland Security and Governmental Affairs Committee’s minority staff.

The Chandler, AZ-based Insys has become notorious for the role it played in advancing America’s devastating, drawn-out opioid crisis, which continues to this day.

Subsys consists of the potent opioid fentanyl, formulated in a spray that allows the drug to work faster. Approved for use in managing cancer patients’ pain, Subsys came on the U.S. market in 2012, and sales grew to roughly $329 million in 2015, at what appears to be the peak.

After a Department of Justice investigation into the company’s promotion of the medication, Insys agreed to pay at least $150 million in fines. Former executives as well as doctors also had criminal charges brought against them.

The new report “pertains to past events involving former employees that would have occurred well before 2016 and have since been dealt with by the company,” said Insys spokesperson Joe McGrath. McGrath had not reviewed the report when he spoke with MarketWatch and did not comment specifically on the facts cited in the report.

Pharmaceutical companies often bring in speakers, usually doctors, to discuss their products and drive sales. Insys viewed speaker programs as the crown jewel of its sales strategy.

The programs “are basically the ONLY thing you should be focusing on to increase your sales,” Sales executive Alex Burlakoff wrote to all sales personnel in 2013, according to the Senate committee report. “If you are not living, eating, and breathing [Insys speakers programs] to drive sales, you should not be in specialty pharma.”

In fact, speaker programs generated six times more revenue per prescriber, according to an internal company presentation cited in the report. Doctors also got more speaking opportunities when they met the prescribing expectations that Insys set for them, the report said.

However, the speaker programs had serious problems, including the omission of safety information in more than one presentation — something an outside consultant brought up with the company in 2014.

Insys later cut down on, and then stopped, the speaker programs, the Senate report — based on 1.6 million pages of internal company documents that were requested by Sen. Claire McCaskill — noted.

Insys also encouraged salespeople to push off-label prescriptions of Subsys, or prescriptions of the drug intended for non-cancer patients, the report found.

An external consultant called this strategy “troubling” in 2016, according to the report, saying that it “incentivized non-compliant behavior and was way outside the norm.”

Internal company communications also instructed employees that they must “own” doctors, including by tracking doctors’ prescribing rates and encouraging them to prescribe more, according to the new report.

Representatives should “[o]wn your territory — own a doctor — and own your destiny,” Burlakoff wrote in another email to sales representatives.

Insys’ opioid sales tactics have been the subject of many additional lawsuits, including from the state of New Jersey and health insurer Anthem. Opioid litigation, which has been brought against many drugmakers and drug distributors, could well rival the well-known lawsuits against Big Tobacco.

Insys shares rose 1% in Wednesday trade. Shares have surged 21.7% over the last three months, compared with a 0.1% rise in the S&P 500 SPX, -0.04%  and a 2.5% rise in the Dow Jones Industrial Average DJIA, +0.26%  . (Click to Source)
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