An up-tempo rap about boosting prescriptions wouldn’t seem out of place at your average pharmaceutical sales meeting. But the video federal prosecutors played Wednesday in the racketeering trial of Insys founder John Kapoor, which focused on the company’s opioid spray Subsys, certainly turned heads.
"I got new patients and I got a lot of ‘em," young Insys sales reps chorused during their five-minute rap, played at a 2015 sales meeting. And the rappers went on to explain how they racked up their numbers, urging fellow sales reps to do the same.
The rappers encouraged their audience to pay for physicians to promote Subsys at dinner events, and they boast not only about new scripts but about doctors boosting their dosages. "I love titration and it’s not a problem," they declare, referring to the process of ramping up opioid doses for patients who've built up a tolerance for the drugs.
Then, as a finale, Alec Burlakoff, a former Insys sales vice president, appears wearing a Subsys costume. The video has since been posted online by the Boston Globe and other publications.
Insys’ aggressive sales tactics are the centerpiece of the case against Kapoor, which is being tried in a U.S. District Court in Boston. Allegations that the company’s sales reps encouraged titration and awarded high-prescribing doctors with fancy meals and the like aren’t new, but the video was a particularly vivid piece of evidence.
Burlakoff, one of several former Insys employees to face charges, pleaded guilty in November to playing a role in a bribery scheme to get doctors to prescribe Subsys, and he agreed to cooperate with prosecutors in the ongoing trial. Kapoor and other executives are also facing allegations that they improperly billed insurers for unnecessary Subsys prescriptions.
A spokesperson for Insys said in a statement emailed to FiercePharma that the company "in no way defends the past misconduct of former employees and is fully cooperating with the government." The company has announced plans to divest its opioid business, she added, and it reached a settlement in principle with the U.S. Department of Justice. The company agreed to pay $150 million to wrap up the investigation of its role in the alleged marketing scheme.
That settlement came a few months before a report released by the U.S. Senate Homeland Security & Governmental Affairs Committee, which summarized 1.6 million pages of internal Insys documents related to its sales practices. Among those were emails from Burlakoff demanding that sales reps recruit more and more physicians and pay them to talk up Subsys among their fellow doctors.
"I want MORE speaker programs now than ever," Burlakoff wrote in one email quoted in the Senate report. "If you determine that [reps] are not doing more programs now than ever before; because they can't fulfill their administrative responsibilities—they must be terminated from lnsys."
In testimony earlier this week, former Insys CEO Michael Babich said Kapoor was so determined to boost Subsys sales that he instituted a bonus structure to reward sales reps who persuaded physicians to prescribe high amounts of the drug, according to Bloomberg. Babich also faced charges and pleaded guilty in the case. He and Burlakoff have not yet been sentenced.
Company documents shown to the jury revealed that Insys’ speaker program delivered revenues of $4.1 million by the end of 2012, Bloomberg reported.
But judging from the video shown three years later at that sales meeting, Insys’ top executives still weren’t satisfied with the Subsys sales effort. "To be great, it takes a decision to be better than the competition," the rapping reps sang. "Get a speaker you can meet with over supper. We can come to your office. We can go and bring some lunch in. While your staff is getting fed we can start discussing Subsys."
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