The drug is called Subsys, a painkiller 100 times more powerful than morphine. Approved by the FDA for cancer patients whose agony can’t be relieved by other narcotics alone, but the drug was prescribed to many who should never have taken it.
Despite the fact that Subsys is known as a “breakthrough for cancer pain”, Insys Therapeutics — the Arizona-based company that sells what can be a highly addictive drug, and nothing else — has sold almost a billion dollars worth of this medication in five years.
NBC’s Senior Investigative Correspondent, Cynthia McFadden, spoke with a former employee who said she was once a part of a plan to get the drug Subsys to patients who never should have had it.
“It was absolutely genius,” Patty Nixon said of the alleged scheme. “It was wrong, but it was genius.”
Nixon, a former Insys sales rep turned whistleblower. “What I did, I was instructed to do, I was trained to do,” Nixon was fired by Insys after she says she felt guilty about lying on the job and stopped showing up for work. She told McFadden. “If I didn’t do it, I was going to be in trouble.”
Fentanyl is the ingredient that gives Subsys so much kick is, according to the company’s website.
Aside from its compounded strength, what sets Subsys apart from other painkillers is the way it’s used — it’s a spray that is absorbed underneath the tongue, the website states.
Nixon said her job was to make sure Subsys got into the hands of as many patients as possible.
“My job responsibilities were to contact insurance companies on behalf of the patients and the doctors to get the medication approved and paid for by their insurance company,” she told NBC.
A 30-day supply costs anywhere from $3,000 to $30,000 which must be a hurdle for the insurers.
Nixon told NBC that her supervisor told her ways to trick the insurers into believing it was “medically necessary.”
“I would say, ‘Hi, this is Patty. I’m calling from Dr. Smith’s office. I’m calling to request prior authorization for a medication called Subsys,'” she told McFadden.
Nixon says she would also mention oncology records that didn’t exist and provide insurance companies with specific diagnosis codes, whether or not the patients had those conditions.
“It was a complete bold-faced lie.”
In one case, it was chronic neck and back pain from two car accidents that prompted Sarah Fuller’s doctor to prescribe Subsys. She did not have cancer.
And when her doctor prescribed Subsys, an Insys sales rep was sitting in the room with them, her father Dave Fuller told NBC News.
Fuller’s prescription was tripled within a month. And 14 months after she started using the drug, she was found dead on a bathroom floor.
What killed her?
“Well, technically fentanyl,” Fuller’s still-grieving mother said. “But a drug company who couldn’t care less about a human life. And, apparently, a doctor who didn’t either.” Fuller’s doctor has since had her license temporarily suspended but denies responsibility for the death.
Sadly, Fuller’s is not the only case.
FDA reports of adverse events, possible related complications, includes hundreds of deaths.
An attorney for Fuller’s family who is suing, Richard Hallowell, said, “this is serious stuff that we’re dealing with … People need to finally be held accountable.”
Nixon later testified before a federal grand jury that indicted the company’s former CEO Michael Babich for fraud, conspiracy and racketeering. All pleading not guilty, five other former Insys executives have also been indicted for racketeering.
Insys founder Dr. John Kapoor is not among the indicted. He is a billionaire who Forbes lists among the wealthiest Americans.
Prosecutors say the company paid hundreds of thousands of dollars to doctors in exchange for prescribing Subsys. Three top prescribers of the substance have already been convicted of taking bribes from Insys.
Insys has denied any responsibility and insists it should not be blamed for how doctors prescribe their products.
Insys is not facing criminal charges and is still selling Subsys — some $240 million worth of Subsys last year alone.