In October 2013, Insys’ vice president of sales, Alec Burlakoff, was determined to recruit as many physicians as possible to speak on behalf of the company’s opioid painkiller Subsys. So he fired off an email to all of the company’s sales reps and managers, demanding that they prioritize speaker recruitment—and that they fire any member of the sales force who wasn’t willing to do so.
“Although our sales organization is well educated, nothing is more powerful [than] a physician's lecture to his or her fellow physicians,” Burlakoff wrote in an email that was provided to the U.S. Senate Homeland Security & Governmental Affairs Committee. “I want MORE speaker programs now than ever,” he continued. “If you determine that they are not doing more programs now than ever before; because they can't fulfill their administrative responsibilities—they must be terminated from lnsys.”
Burlakoff’s email was among 1.6 million pages of internal Insys documents provided to the Senate in response to a 2017 request from Claire McCaskill (D-Missouri), the ranking member of the committee, which released a 193-page report on its investigation Wednesday. While the information in the report (PDF), called “Fueling an Epidemic,” was generally known before, it provides a granular look at how one company allegedly drove the opioid epidemic largely by paying physicians to talk up its fentanyl drug Subsys. It gets at a major concern of lawmakers: the role of doctors in fueling the opioid epidemic.
A spokesperson for Insys pointed out in an email to FiercePharma that the Senate report focuses on "past misdeeds by former employees." Today's Insys, he added, "is a different company," with a new governance and management team that is "committed to a new culture." Insys is also diversifying beyond painkillers, with a pipeline that includes medicines to treat epilepsy and severe allergic reactions, he said.
The law firm representing Burlakoff did not immediately respond to a request for comment from FiercePharma.
Burlakoff was among several former Insys employees who were charged back in 2016 by the U.S. Attorney's Office of the District of Massachusetts for allegedly bribing physicians to prescribe Subsys. In August, the company agreed to pay the Justice Department $150 million over five years to settle a criminal investigation. However, there are still pending False Claims Act charges against the company and separate indictments of former employees.
The Senate report isn’t entirely surprising: The previous charges filed against Insys and its former leadership revolved around aggressive sales tactics they allegedly used to fuel opioid sales. But the level of detail provided by Burlakoff’s emails and other documents handed over to the Senate offer a rare insider’s view of a company leaning on its physician partners to help drive sales.
Insys’ sales reps weren’t just expected to recruit physicians as speakers on behalf of Subsys; they were charged with “owning” doctors in their territories, the Senate report alleges. Among the evidence is an email Burlakoff wrote in December 2012 demanding that sales reps continue to generate one prescription a day for Subsys regardless of the fact that physicians were taking time off for the holidays.
“Holidays never hurt the representatives whom OWN five doctors,” he wrote. “In fact, even if all doctors are out of the office at one time … a good rep [will] make sure … a Subsys rx is written!”
Burlakoff went on to promise “big bonus dollars” to reps who met the one-prescription-per-day goal, and he threatened to withhold bonuses from those who didn’t. The higher the Subsys dose prescribed, the bigger the bonus awarded to the corresponding sales rep, according to a 2013 compensation plan provided to the Senate.
The role of doctors in the Insys saga has long been a concern to lawmakers. In March of this year, the Justice Department indicted five Manhattan doctors on charges that they took bribes from Insys in return for writing more Subsys prescriptions. They pleaded not guilty.
Despite Insys’ recent efforts to clean up its corporate culture, the Senate committee that produced the new report remains concerned about the precedent the company set. Insys may not have invented physician speakers’ bureaus, the report concluded, but “the next pharmaceutical company moving rapidly to establish market share in a crowded field may look to Insys as a model,” it argued. “And so long as both sales representatives and prescribers have strong financial incentives to boost prescriptions, simple greed will continue to distort the patient-physician relationship.”