A federal jury on Thursday found the top executives of pharmaceutical company Insys Therapeutics guilty of criminal racketeering for orchestrating an elaborate scheme of bribes and kickbacks to doctors to boost the prescribing of an opioid painkiller it manufactured. The landmark conviction of Insys founder and former chairman John Kapoor is the first of a drug company CEO in the federal government’s pursuit of those responsible for fomenting the deadly opioid crisis. Kapoor and other executives at the Arizona-based company could face prison sentences for the felony convictions that run as long as 20 years.
The details of the company’s sales practices are chilling: To help boost the number of prescriptions and its bottom line, Insys created incentives for doctors that pushed them to prescribe highly addictive pain medication, usually reserved for cancer patients, to patients who didn’t medically require it. The company profited from the wider distribution of the under-the-tongue fentanyl spray Subsys, which can be as much as 100 times more potent than morphine. The drugmaker paid the doctors with lucrative speaking slots at marketing events, some of which could run into hundreds of thousands of dollars. The company then misled insurance companies to cover the wider pool of patients prescribed the drug, which could run as high as thousands of dollars each month, further boosting annual sales that at one point topped $300 million.
“Former Insys sales representatives, testifying for the prosecution, said their bonuses were tied to the dosages of Subsys prescribed by the doctors they recruited,” the New York Times reports. “The higher the dose, the higher the bonus. Evidence presented in court showed that sales representatives had to justify low doses to their boss within 24 hours. Not only did Subsys cost more at higher doses, but patients were also more likely to become dependent on the highly addictive medication.”