Employees of Insys Therapeutics allegedly used a wide range of ploys involving insurers and pharmacy benefit managers (PBMs) to obtain approvals for reimbursement of the company’s fentanyl product (Subsys) costs, according to a new congressional report released by the U.S. Senator Claire McCaskill on Sept. 6, 2017. One of the tactics included posing as doctor’s staff and lying about the cancer status of patients. Subsys, which is a powerful synthetic opioid, was approved in 2012 for managing chronic pain in patients battling cancer.
According to Senator McCaskill’s report, in 2013, the company formed a staff unit to ensure the success of its product with the “prior authorization” process, which is a key component in the insurance sector to curb misuse and abuse of costly drugs such as Subsys. But, as per the report, Insys employees allegedly committed systematic frauds to get around the prior authorization process. The report includes an exposé involving recorded telephonic conversations between an Insys employee and representatives from Envision Pharmaceutical Services, a PBM, for a Subsys prescription for Sarah Fuller, a patient from New Jersey.
According to media reports, despite not having cancer, Fuller was prescribed Subsys by her doctor. She died of a Subsys overdose in 2016.
Opioid abuse is wreaking havoc in America
Popping pills have become a daily ritual for most Americans. According to the Centers for Disease Control and Prevention (CDC), opioids, including prescription drugs and heroin, claimed more than 33,000 lives in 2015. Also, about 25 percent people who use prescription opioids long term for non-cancer pain in primary care settings struggle with an addiction.
Although relatively safe in the short-term when taken as per the dosage prescribed by a doctor, prolonged or non-medical use of opioids can lead to dependence and addiction. In fact, a majority of opioid abusers gradually turn to heroin as a cheaper alternative when they do not have access to the prescription pills anymore.
The CDC suggests that medical practitioners writing millions of prescriptions for opioid painkillers have fueled the epidemic, which is now ravaging the nation. People should be made aware of the risks of prescription drug abuse by authorities as well as health care givers. Addiction to opioids can be treated. Health care providers need to identify patients who stand at a greater risk of abuse and also ensure that those treated with opioids, receive only the required quantity of medication.
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