It’s time for this week’s edition of Investigative Roundup, gathering some of the best investigative reporting on healthcare from around the country.
Rappers, Damning Testimony on Opioid Sales Tactics
The Boston Globe reports on the latest in the Insys racketeering conspiracy trial: jurors sat back and watched a company-produced rap video featuring Insys’ sales representatives and a dancing (and yes, rapping) human-sized maximum-dosage spray bottle of Subsys — “I love titration, yeah that’s not a problem. I got new patients, and I got a lot of ’em.”
It was later revealed that inside the spray bottle was a former Insys vice president who last year pleaded guilty to a count of racketeering conspiracy, which carries a sentence of up to 20 years.
Surprisingly, the rap video didn’t steal the show the day of the trial, that honor went to the the damaging testimony of a former company executive, Michael Babich, who last month pleaded guilty to mail and wire fraud and is cooperating with prosecutors.
Babich described the company’s tactics for targeting high-opioid-prescription doctors and how he felt the company “owned” them through “bribes” paid under cover of a “sham speakers program.”
The FDA has recently come under fire for its oversight of the risk management and management strategy (REMS) program for Subsys — a sublingual fentanyl spray intended for cancer patients with breakthrough pain — with critics accusing the agency of failing to act when it learned of inappropriate Subsys prescribing.
Not wanting to be left out of the social media craze, pharmaceutical and device companies are using so-called influencers on Instagram to market Botox, surgical techniques, psoriasis treatments, and devices for type 1 diabetes and other ailments, Vox reports.
The photo- and video-sharing platform — which is synonymous with sun-soaked selfies — is projected to have over 1 billion users this year, and for pushing pharma ads these influencers get paid an estimated $1,000 per 100,000 followers.
For example, one social media celeb touted the benefits of ReSensation, a newer surgical technique that purports to help with breast sensation for women undergoing reconstruction surgery. However, the Instagrammer never used ReSensation, and her nearly half a million followers wouldn’t have known that unless they clicked into the post’s caption where they were directed to a link to a blog in her bio (but these links change frequently, making it more difficult to find information).
While there are guidelines for disclosure, the FDA and Federal Trade Commission “do not attempt to survey all influencers or influencer posts, either alone or with [the help of] social media platforms,” the article reports. Either way, Instagram influencers can bury the disclosures in the copy of their posts and through subtle hashtags — in some cases followers may never realize their posts are advertisements.
Spotlight on Price-Fixing Scheme Documents
New details of an alleged generic-drug price-fixing scheme have emerged in unredacted court documents obtained by STAT. The documents stem from a lawsuit filed by 47 states that accuse 17 drugmakers of the illegal practice.
Some examples revealed in the article: “an executive at a pharmaceutical company had an employee email a competitor to discuss strategy. In another, a drug maker allegedly struck a bargain with another so that each company could maintain its respective market share. And in yet another, prosecutors say, two pharma companies compared notes while simultaneously boosting prices of their drugs.”
One email exchange concerns the drug doxycycline monohydrate: “I hear that Lannett is taking a price increase on doxy mono and Heritage will follow,” a vice president from Par Pharmaceutical wrote, which was then forwarded internally at the company with the message, “we will follow.”
$120 Million Bill for Inappropriate Rx?
CNN reports that Avanir Pharmaceuticals may have to fork over $120 million in “fines, restitution, legal fees, and other liabilities” related to a Department of Justice (DOJ) investigation into the drugmaker’s aggressive marketing of dextromethorphan hydrobromide and quinidine sulfate (Nuedexta).
While the drug was originally approved for pseudobulbar affect in 2010 based on trials in patients with amyotrophic lateral sclerosis or multiple sclerosis, a recent analysis of insurance claims data found that it most often was prescribed for two other underlying disorders — dementia and Parkinson’s.
The DOJ says Avanir sales reps targeted patients with these disorders for off-label use, most of whom were elderly, on Medicare, and often in nursing homes — which critics have called an “uncontrolled experiment.” In 2016, Medicare paid out $200 million related to Nuedexta prescriptions.
Another Major Kickback Case
In Texas, 10 defendants go on trial today in an alleged $200-million kickback scheme involving multiple physicians, hospitals, pharmacies, and other businesses, according to the Dallas Morning News.
Prosecutors say the more patients that doctors and other medical professionals sent to the now-defunct Forest Park Medical Center (for expensive operations like bariatric and spinal surgeries), the more they were paid, with kickbacks totaling $40 million in all.
One physician allegedly demanded a place to land his helicopter from Forest Park, as well as a package of four lifetime seats to Dallas Cowboys’ games (which apparently cost a neat $1 million).
The accused contend that they did not break any laws, and that the money they received were “marketing payments” which were OK’d by healthcare attorneys, and wasn’t tied to the number of patients they sent the hospital’s way.