Insys Therapeutics Inc. founder John Kapoor didn’t cut corners when it came to collecting intelligence on opioid sales, using the data to beat down his employees and to spur doctors to prescribe more of his highly addictive painkiller, a Boston jury was told.
Insys tracked every prescription written for their competitors’ drugs by buying daily federal data, Alec Burlakoff, former vice president of sales, testified at Kapoor’s racketeering trial. Data from the Transmucosal Immediate Release Fentanyl (TIRF) Risk Evaluation and Mitigation Strategy (REMS) program, commonly known as TIRF REMS, is used to alert doctors to the risks of misuse, abuse and addiction of medicines that contain fentanyl.
“Intelligence was something Dr. Kapoor did not cut corners on,” Burlakoff, 45, testified. The daily reports were available, “if you were willing to pay crazy, astronomical amounts of money.”
The testimony Tuesday from Burlakoff adds to the catalog of dubious methods Insys used to spur sales of its Subsys opioid painkiller. The jury had already heard that the company used phony speakers’ fees to bribe doctors to prescribe Subsys, or increase the dosages. Burlakoff hired a former stripper with no experience as sales manager, who, witnesses said, had used her sex appeal to persuade physicians to write more prescriptions. And the jury had also heard that call center representatives duped insurers into paying for Subsys to patients who didn’t need the powerful drug.
Subsys was approved only for cancer patients with “breakthrough” pain, but the jury was told that doctors prescribed it to people with arthritis, depression and back pain.
Kapoor, 75, studied the TIRF REMS data closely every day, including the doses prescribed for Subsys, according to Burlakoff. Kapoor was upset when doctors in the speakers’ program weren’t increasing doses, Burlakoff said.
Each morning during the “8:30 beatdown” with Kapoor, Burlakoff said he had to be prepared to explain why a doctor wasn’t increasing dosages.
“If someone wrote a competitive product for the first time, it was not going to be a good day in the office,” Burlakoff said.
Sales representatives were ordered to drop everything and visit that physician within 24 hours and “do whatever it took to get the doctor on board,” he said.
“It was micromanagement that I’ve never seen in my life,” Burlakoff said.
That testimony strikes at the heart of Kapoor’s defense. His lawyers made it clear to jurors in opening statements that he’ll blame his subordinates for any wrongdoing.
Burlakoff testified Tuesday he knew bribing doctors was a crime, but never talked directly to Kapoor about their criminal risk and would advise him about meetings with doctors only in general terms.
“Typically within 24-48 hours after a meeting took place, I would send an email, which was a little bit generic because I didn’t want to create a poor paper trail that would get the company in trouble,” he said.
The case is U.S. v. Kapoor, 16-cr-10343, U.S. District Court, District of Massachusetts (Boston).
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