Biopharma giant AbbVie Inc. illegally bribed healthcare providers to prescribe its best-selling but deadly arthritis drug, Humira®, alleged a lawsuit filed Tuesday.
The case, filed by the California Department of Insurance on behalf of the state of California, alleges that private insurers paid out more than $1.2 Billion for over 274,000 Humira-related claims between 2013 and 2018. That would make this healthcare fraud case the largest in department history.
AbbVie Sued Over Systematic Fraud
According the complaint, AbbVie gave doctors illegal kickbacks ranging from the classic – cash, gifts, and patient referrals, for example – to the more sophisticated professional services.
Most disturbing about AbbVie’s alleged scheme was its door-to-door approach. When doctors prescribe Humira, AbbVie sends registered nurse “Ambassadors” to visit the patient’s home posing as extensions of the doctor’s office. AbbVie would use patients’ trust of nurses and direct access to their homes to serve its own financial agenda: downplay Humira’s risks for sales.
“AbbVie spent millions convincing patients and health care professionals that AbbVie Ambassadors were patient advocates,” said Insurance Commissioner Dave Jones, who first filed to intervene in August. “In fact, the Ambassadors were Humira advocates hired to do one thing: keep patients on a dangerous drug at any cost.”
Considering Humira’s history of severe side effects, the cost could have been life.
‘Ambassadors’ Downplayed Deadly Risks
Humira is an injectable drug marketed as a treatment for rheumatoid arthritis and other inflammatory conditions. With sales of over $12 Billion in 2017, Humira is hailed as the best-selling drug in the world.
Yet it also tops the Food and Drug Administration’s (FDA) list of drugs with the most adverse event reports. Between 2013 and 2017, the drug was linked to about 209,000 reports including more than 4,200 deaths. AbbVie has paid out millions in lawsuits for side effects like leukemia and life-endangering infections.
It is the Ambassadors’ job to hide these risks. They are trained by AbbVie to tout the drug, dodge patients’ questions about potential side effects, and take any patient complaints back to the company rather than the patient’s doctor.
Meanwhile, AbbVie saves doctors considerable time and resources by providing them free professional services, including anything from insurance processing and insurance product advice to help with paperwork and marketing. The catch? AbbVie only offers services for as long as the doctor chooses Humira over alternative prescriptions.
The whistleblower for California’s case, as it turned out, was 1 of AbbVie’s own Ambassadors. The unnamed nurse had become troubled about the program’s “emphasis on the bottom line.”
AbbVie Could Pay Billions
In an ironic twist of fate, the financial consequences for AbbVie look dire. The company’s shares immediately dropped 2.3 percent on Tuesday, added to a 5.3 percent drop over the last few months. In its complaint, the California Department of Insurance asked for compensation of 3 times the amount of each claim made for Humira. This could amount to billions of dollars in penalties.
But worse is the effect on patients. AbbVie claimed its support services were designed to educate and assist patients with their therapy. Instead, the scheme drove up insurance costs, denied patients important information, and tainted their relationships with their doctors, while putting them at serious risk of death.
This case will hopefully serve as a two-fold warning: that Humira is dangerous, and that pharma companies can (and often do) engage in illegal practices that aren’t in patients’ best interests.
“Pharmaceutical companies know financial inducements are illegal, and patients depend on their health care professionals for straight forward honest information about their care and medication risks,” said Jones. “In this case, patient care was traded for $1.2 billion in ill-gotten gains.”