The goal for Insys Therapeutics Inc.’s call center in Phoenix was simple: persuade insurers to authorize at least 70 prescriptions a week of its expensive opioid spray.
Workers would get bonuses for surpassing the goals, a former call center manager testified. Even if the patient had minor skin cancer decades earlier, employees were told to lie to insurers to get approval for the powerful and expensive drug, which had only been approved for “breakthrough” cancer pain, Elizabeth Gurrieri told a Boston jury.
“So almost every call from the Insys reimbursement center included lies and misrepresentations?” Assistant U.S. Attorney David Lazarus asked Gurrieri.
“Most of them, yes,” she replied.
Gurrieri took the witness stand Friday in the trial of Insys’s founder John Kapoor and four other former executives. As the trial enters its fifth week, Gurrieri is helping prosecutors paint of portrait of a pharmaceutical company that cared only about its bottom line. After witnesses described unethical and high-pressure sales practices, prosecutors have begun showing how the company routinely lied to insurers who would pick up the tab for the drug Subsys.
The pressure came from the top, Gurrieri told the jury Monday.
Kapoor “yelled a lot” on weekly sales calls, she said. “He was angry a lot, very demanding.”
The jury heard recordings of Insys call center employees repeatedly claiming to insurers that patients needed Subsys because they suffered from severe cancer pain, even though they weren’t actually diagnosed with cancer.
Gurrieri identified each call played and confirmed from medical records the referred patient didn’t have cancer.
The Insys employees claimed to be calling from a doctor’s office and also used “the spiel,” falsely claiming for example that a patient had trouble swallowing, a condition known as dysphagia, which often won approvals for Subsys, she said.
The spiel was developed based on a study of what would win insurance approval and included lies about patients’ medical history, Gurrieri said.
Michael Gurry, her boss, encouraged the call center employees to find ways to win the insurance approvals and get around their questions, she said.
Gurry told Gurrieri to “ride the gray line” in calls to insurers from the Phoenix reimbursement center, where the location of outgoing calls was blocked, she said.
Kapoor, 75, and four other Insys executives, including Gurry, 54, are on trial in Boston on charges of racketeering through a nationwide scheme to boost sales by bribing doctors to prescribe the addictive painkiller Subsys and lying to insurers. The drug was FDA approved for severe pain from cancer.
Gurrieri pleaded guilty to wire fraud conspiracy in 2017, and said she expects to serve at least 18 months in prison under her agreement with the government. She previously worked for McKesson Corp. and had 14 years of experience in health care when she started at Insys in the fall of 2012. Her testimony continued Monday.
Prosecutors showed jurors a March 2013 email from Gurry urging his team to win more authorizations. “I can feel a 70 approval week,” he wrote. “Let’s maximize the dollars all of you can earn.”
Gurrieri, who said she earned about $400,000 during her career at Insys, claimed her boss instructed the team to hang up if an insurance company was resisting covering the drug and call back.
“Meaning call back and try to fool somebody else?” Lazarus asked.
“Yes,” she said.
The case is U.S. v. Kapoor, 16-cr-10343, U.S. District Court, District of Massachusetts (Boston).
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