One Drug, One State, $1.2B In Suspected Fraud

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Big Pharma kickbacks result in state’s largest fraud case ever

| Catherine Ho, SF Chronicle – California Insurance Commissioner Dave Jones on Tuesday sued drugmaker AbbVie, alleging that the company offered kickbacks to health care providers to prescribe the popular arthritis drug Humira, resulting in health insurers paying $1.2 billion in fraudulent claims — the largest health insurance fraud case the Department of Insurance has ever seen.

The lawsuit, filed in Alameda County Superior Court, accuses AbbVie of illegally offering cash, meals, trips, drinks and patient referrals to physicians across California in order to ensure that they would continue prescribing Humira, a popular drug for Crohn’s disease and rheumatoid arthritis.

The complaint also alleges that between 2013 and August 2018, AbbVie deployed registered nurses to the homes of patients who had been prescribed Humira to serve as so-called Humira “ambassadors.”

These nurses believed they were supposed to help with patient care but in fact were instructed by AbbVie not to communicate patients’ concerns about Humira’s side effects to their physicians, the suit says.

AbbVie, which is headquartered in Illinois, said the allegations are without merit and issued a statement defending its practices.

Humira is a blockbuster drug for AbbVie, representing about $18.4 billion in sales in 2017. Last year, the drugmaker projected that Humira sales were on track to hit $21 billion in 2020.

Read more at San Francisco Chronicle.

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