Published: Fri, September 21, 2018
Medical | By

California insurance commissioner sues AbbVie over Humira

California insurance commissioner sues AbbVie over Humira

The State of California has demanded a jury trial, and is seeking injunctive relief, assessments of 3 times the amount of each claim for compensation for insurance contracts on Humira, and civil penalties of $10,000 for each fraudulent claim presented to an insurance company. It's global sales topped $18 billion United States in 2017.

AbbVie Inc. generated almost $1.3 billion in tainted health insurance claims for its blockbuster immunosuppressant Humira by paying kickbacks in the form of cash, alcohol, trips and an elaborate network of "nurse ambassadors", California regulators said in a complaint filed Tuesday.

California's insurance commissioner on Tuesday sued AbbVie alleging a kickback scheme created to convince doctors to prescribe the biopharma's top-selling biologic drug Humira over competing medicines.

The suit claims that the ambassadors were incentivized with money, gifts, trips, and additional professional assistance. That figure makes the lawsuit the largest health care fraud case in the state insurance department's history, according to Jones's office.

Over a five-year period, the drug maker offered physicians a familiar menu of tempting items, from cash, meals and drinks, to gifts and trips, along with patient referrals, in hopes they would write more prescriptions for its Humira rheumatoid arthritis treatment, a $12.3 billion seller in the US last year.


Calling the allegations "without merit" in an interview with the Los Angeles Times' James Rufus Koren, AbbVie spokeswoman Adelle Infante defended the company's use of nurses to work with patients. The kickback scheme also included nurses whom the company sent to the homes of patients taking the drug, the lawsuit says.

The allegations of AbbVie's misconduct were brought to the attention of the department by a whistleblower, a registered nurse who was employed as an AbbVie Nurse Ambassador in Florida.

AbbVie said nursing help and other support services that it provides educate and assist patients with their therapy and "in no way replace or interfere with interactions between patients and their health care providers". Beyond ensuring that patients remained on the drug, the nurses allegedly were instructed to report any patient questions or complaints to AbbVie, rather than individual physicians. These nurses trained patients on administering their subcutaneous injections and provided patient care, paperwork help, and other services, all of which alleviated burdens on prescribers' practices in exchange for selecting Humira from a range of available treatments. "These private nurses, paid by AbbVie, attenuate the direct relationship between the patient and their healthcare provider in troubling ways".

Rheumatology, gastroenterology, and dermatology practices generally employ nurses, prior authorization experts, and other staff to provide insurance advice and counseling to patients.

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