“The decisions, the money, the strategy came from the top,” K. Nathaniel Yeager, a federal prosecutor, said during closing arguments.
Details of Insys’s strategy from 2012 to 2015 to target doctors and allegedly bribe them have been revealed in lawsuits and news reports for about five years. The trial of Mr. Kapoor and his four co-defendants has brought to light the extent to which the schemes permeated the entire company and its national sales team.
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 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. Subsys is up to 100 times more potent than morphine.
Alec Burlakoff, the former vice president of sales at Insys, has pleaded guilty to one count of racketeering conspiracy. He wrote in an email read at trial that patients on high doses would be desirable because they “will continuously refill their monthly prescriptions indefinitely.” Court filings in a separate case suggest Purdue Pharma, the maker of OxyContin, pursued a similar strategy.
Two Insys sales representatives made a rap video in 2015 about titration, the technique used to increase a patient’s dose. The main lyric: “I love titrations, and it’s not a problem. I got new patients, and I got a lot of them.” The video, in which the salesmen dance alongside a person in a Subsys dispenser costume, was shown at a national Insys sales staff meeting where Mr. Kapoor was present.
The government is saying, “We have got to do something about the flow of opioids in this country — not from across the borders, not from people’s kitchens where they’re made and converted — but from the pharmaceutical companies that are making billions,” Mr. Bailey said.
In a similar effort to hold individuals accountable, the attorneys general in New York and Massachusetts have recently turned their attention to the Sacklers, the family that controls Purdue, filing lawsuits that allege members of the family pushed their company to aggressively sell opioids like OxyContin, despite the high risk for addiction.
While the legal strategy may be noteworthy, evidence has emerged that aggressive marketing of opioids is far from unique to Insys.
“The Insys story is symbolic, representative of the kind of conduct, the kinds of things that have been going on behind the scenes to fuel this opioid crisis,” said Gregory Curfman, deputy editor of the Journal of the American Medical Association.
Government lawyers called witnesses and presented their arguments over the course of two months. Defense lawyers rested their case in less than three days.
Beth Wilkinson, the lawyer for Mr. Kapoor, sought to persuade the jury that many of Insys’s marketing strategies were commonplace. Pharmaceutical companies often hire physicians to help promote their medications.
“In this country, that’s not illegal. In fact, it’s not even unusual,” Ms. Wilkinson told the jury during opening statements. Plus, she explained that “all the information is public” on the government’s Open Payments Data website.