California Insurance Commissioner Dave Jones has filed an insurance-fraud complaint in Alameda County Superior Court alleging that AbbVie provided illegal kickbacks to health care providers for prescribing Humira (adalimumab), Jones said in a teleconference today.
"AbbVie spent millions convincing patients and healthcare professionals that AbbVie Ambassadors were patient advocates the Ambassadors were Humira advocates hired to do one thing, keep patients on a dangerous drug at any cost," Jones said in a news release.
"Pharmaceutical companies know financial inducements are illegal, and patients depend on their healthcare professionals for straightforward, honest information about their care and medical risks," Jones said.
Jones added that Humira is an expensive drug with the potential for serious adverse effects and that private insurers have paid out $1.2 billion in pharmacy claims related to the drug.
Claims "Without Merit"
"AbbVie operates in compliance with the many state and federal laws that govern interactions with healthcare providers and patients," according to the statement from Adelle Infante, director of external communications for AbbVie.
"AbbVie provides a number of support services for patients, once they are prescribed Humira, that both educate and assist patients with their therapy, including nursing support, and these resources are beneficial to patients dealing with a chronic condition. They in no way replace or interfere with interactions between patients and their healthcare providers."
Jones, the California insurance commissioner, disagrees. "AbbVie's misconduct is particularly egregious because the company has long known Humira has dangerous side effects," Jones said.
The drug has a US Food and Drug Administration black box warning about adverse effects including serious infections and certain cancers. It is used for the treatment of conditions including arthritis, ulcerative colitis, and Crohn's disease.
The case has been filed on behalf of the State of California under the Insurance Frauds Prevention Act, and Jones said it is the largest health insurance fraud case in department history.
The complaint alleges that AbbVie "engaged in a far-reaching scheme including both classic kickbacks — cash, meals, drinks, gifts, trips, and patient referrals — and more sophisticated ones — free and valuable professional goods and services to physicians to induce and reward Humira prescriptions.
The professional goods and services included free insurance processing and prior authorizations, gifts of medical practice management hardware and software, and even marketing assistance, all of which save physicians valuable staff time and resources," according to the news release.