Senator Claire McCaskill’s office on Wednesday released audio that explains how many in America fell victim to the opioid crisis.
It’s a phone call between an employee from Insys, the Arizona-based maker of Subsys, and a pharmacy benefit manager (PBM). The PBMs is supposed to ensure that everyone who gets Subsys has cancer — that’s the pain the drug is supposed to treat.
But the patient in question, Sarah Fuller, didn’t have cancer. The Insys employee just did whatever they could to make it sound like she did. It was a success. Fuller did get the Subsys prescription, and eventually died of a Subsys overdose on March 25, 2016.
The audio accompanies a report from McCaskill’s office on Insys’ marketing and business practices. What McCaskill found was a systematic plot to give as many patients as possible cancer (on paper) so that doctors would prescribe the drug.
PBMs use something called prior authorization to ensure that only patients who need certain drugs get them. To override a prior authorization you need special permission from your doctor.
So Insys employees just pretended to be calling “with” a doctor’s office. Words are very important here. Insys patients didn’t necessarily have to say a patient had breakthrough cancer pain, they just had to agree a lot and say the patient had breakthrough pain.
That’s what happened when Insys called Envision Pharmaceutical Services, a PBM, to get through the prior authorization for Sarah Fuller. You can listen to the call here.
From the report [emphasis ours]:
As the conversation with the Envision clinical department representative proceeds, the Insys employee correctly notes that Subsys is “intended for the management of breakthrough cancer pain,” but then states only that Dr. Matalon is treating Ms. Fuller for “breakthrough pain.”
When questioned as to whether Ms. Fuller does, in fact, suffer from breakthrough cancer pain, the Insys employee avoids responding directly and instead explains “there’s no code for breakthrough cancer pain.”
She then states again that the Subsys prescription is “for breakthrough pain, yeah,” and the Envision representative discontinues this line of questioning. Toward the end of the call, the Insys employee states that Ms. Fuller is anticipated to remain on Subsys indefinitely.
Fuller was ultimately admitted into a local hospital with “hypersedation with hypoxia secondary to narcotics and sedatives.” Her doctor was told not to give her any more Subsys, but that was ignored. In fact, Fuller was also prescribed Percocet, OxyContin, and Alprazolam, over the next five months.
Since a number of its executives, including a former CEO, were arrested last December, Insys has become the poster child for everything wrong with the opioid epidemic. Former employees and medical practitioners have testified in a Massachusetts court and pleaded guilty to helping the company with this scam, and the state of Arizona just opened an investigation into the company’s marketing practices. We reached out to Insys for comment and we’ll update this post if we hear back.
Insys isn’t the only company being investigated. On top of Insys, the Attorney General of Missouri, Josh Hawley, is also looking at the business practices of Mallinckrodt, an OxyContin maker, as well as Teva, Allergan, Depomed Inc, Pfizer and Mylan (the maker of EpiPen). In June he sued Purdue Pharma Inc., Endo International Plc and Janssen Pharmaceuticals Inc. for misrepresenting the dangers of opioid use.
The takeaway from all of this is simple. The opioid crisis didn’t start with “bad hombres” coming in from Mexico. It started in board rooms across corporate America. Until people understand that, they won’t understand how to stop it.