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State sues drug maker over kickbacks

State Insurance Commissioner Dave Jones sued the maker of an arthritis drug in Alameda County Superior Court Tuesday for alleged insurance fraud, claiming the drug is sold through illegal kickbacks to doctors.

The lawsuit against AbbVie Inc. of North Chicago, the maker of Humira, was filed on behalf of the state of California.

It alleges AbbVie induces doctors to prescribe the drug by giving the physicians kickbacks in the form of free services of nurses to advise patients, free insurance processing, medical management software, cash, meals and trips.

The nurses, known as ambassadors, visit patients in their homes. The lawsuit alleges they are trained to downplay the risks of the medicine, to try to keep patients on Humira and to relay patients’ concerns to the company rather than to their doctors.

Jones alleged in a statement today:

“AbbVie spent millions convincing patients and health care professionals that AbbVie ambassadors were patient advocates. In fact, the ambassadors were Humira advocates hired to do one thing, keep patients on a dangerous drug at any cost.”

Humira is used to treat a number of conditions including rheumatoid arthritis, psoriatic arthritis and Crohn’s disease, among others.

Its side effects can include tuberculosis; lymphoma; fungal, viral and bacterial infections; blood problems and heart failure, according to the manufacturer’s warning label.

AbbVie sold $17 billion worth of the drug nationwide last year, according to the lawsuit. Within California, private insurers paid $1.29 billion between 2013 and August 2018 to cover 274,000 patient claims during that period, the lawsuit said.

The lawsuit alleges AbbVie has violated the California Insurance Frauds Prevention Act by using kickbacks to pay doctors “to prescribe Humira far in excess of the amount that they would have prescribed this expensive and dangerous drug absent the illegal kickbacks.”

The lawsuit asks for financial compensation in triple the amount of any fraudulent insurance claims and for an injunction stopping the alleged practices.

AbbVie communications director Adelle Infante said in a statement:

“We believe the allegations are without merit. AbbVie operates in compliance with the many state and federal laws that govern interactions with healthcare providers and patients … 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.”

The lawsuit started out as a whistleblower case filed by Lazaro Suarez, a nurse who worked as a company ambassador in Florida in 2013 and 2014. In February, Jones told the court in a sealed document that the state would join the case.

Suarez remains a plaintiff along with the state in the version filed today, and will be entitled to a share of the financial proceeds.

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