The racketeering trial of five former Insys Therapeutics executives accused of bribing doctors across the country to increase their prescriptions of Subsys took place earlier this year. As a refresher, Insys founder John Kapoor and four former high-ranking executives are on trial for allegedly funneling millions of dollars in kickbacks and bribes to prescribers to get them to prescribe the Insys drug, Subsys. Subsys was initially approved to treat cancer-related pain and had at least four other fentanyl-based products as competition.
As was expected, testimony that came out during the trial was shocking, including testimony that Insys hired an ex-stripper as a sales manager and that employee even gave a doctor a lap dance. A former Insys Therapeutics sales representative, Holly Brown, testified before jurors that she was present when her boss, former exotic dancer Sunrise Lee, Dr. Paul Madison a lap dance in a Chicago nightclub in mid-2012 following a dinner at Insys founder John Kapoor’s Chicago restaurant. According to Brown, when she had discussed with Lee her qualifications for holding the sales manager position, the only response she received from Lee was that she had worked in massage therapy and “at some point she said she had a degree in biochemistry.”
Dr. Gavin Awerbuch, a Michigan doctor who has been convicted of illegally distributing Subsys, testified to the attractiveness of the company’s sales reps and the “easy money’’ that helped to persuade him to write unnecessary prescriptions for the dangerous drug. He told jurors that he made over $130,000 over the course of just 18 months by showing up to “educational sessions.” According to Awerbuch, Insys officials would set up speaking engagements but often couldn’t get any doctors to attend. In those cases, Awerbuch would have his neighbors and friends show up, while on other occasions, it was just him and a sales rep at the dinner table. He testified that “It was just easy money for me. I got paid $1,600 to show up, have a nice meal and go home.”
Michael Babich, former Insys chief executive, has cut a deal with prosecutors and, following his guilty plea to conspiracy to commit mail fraud and wire fraud and to mail fraud, served as a witness in this current case. In his testimony, he said that he felt the company “owned” several doctors who had received thousands of dollars from Insys to prescribe Subsys, and he didn’t want them to prescribe other competing fentanyl products.
Babich also reviewed dozens of emails that had been entered into evidence and testified that high-ranking executives at Insys painstakingly identified doctors around the country who had a history of prescribing opioids, then wooed those physicians and funneled what he called bribes to them through a sham speakers program. He further testified that he, Kapoor, and Alec Burlakoff, among others had a conference call almost every weekday morning at 8:30 am to review how many prescriptions the doctors were writing and at what dosages, to determine whether the company was getting a good “return on its investment.”
Babich also testified against Kapoor more specifically, highlighting Kapoor’s anger about the launch of the drug because he felt patients were not being prescribed high enough dosages and would eventually stop taking the drug. According to Babich, Kapoor “called it the worst (expletive) launch in history.”
The Rap Video
At this point, most in the industry have likely seen the in-house rap video that was created featuring A$AP Rocky beats and an executive dressed as a prescription bottle of Subsys. The executive featured in the video, Alec Burlakoff, was the vice president of marketing at Insys. Some of the lyrics in the rap included, “You think you’re bad well I’m the baddest / I was created in a lab with the land of the cactus.” The chorus praised “titration,” which is a process to quickly increase the dosage of Subsys, “I love titration. Yeah it’s a not a problem. I got new patients and I got a lot of ‘em.”
The music video, five minutes long and shown at an Insys sales conference in 2015, was titled “Great by Choice” and focused on the benefits of pushing physicians and other prescribers to prescribe the pain medication.
If nothing else, the trial and corresponding testimony highlights the fact that Insys had no consideration as to the dangers that their drug represented, and this case shows that unfortunately, there are some people who take advantage of the system and have blatant disregard for the people they are supposed to be helping. The rap video especially shows the level of incompetence of Insys executives, as they did not seem to understand how dangerous fentanyl is and how titration can often lead to death. The trial and testimony shows just how out of touch – and out of control – the executives at Insys were.