Two young Insys Therapeutics salesmen wearing sunglasses and hoodies danced next to a giant spray bottle depicting the drug firm’s opioid product, in a thumping rap video made to prod sales representatives to get more doctors to prescribe the addictive painkiller.
“Insys Therapeutics, that is our name,” the associates sang. “We’re raising the bar and we’re changing the game. To be great it takes a decision, to be better than the competition.”
The five-minute video debuted in 2015 at an Insys national sales staff meeting, according to federal prosecutors. They played it Wednesday to a rapt US District Court jury in Boston in the racketeering conspiracy trial of John N. Kapoor, founder of Arizona-based Insys, and four former high-ranking company executives.
The five defendants allegedly funneled millions of dollars in bribes and kickbacks to key practitioners to get them to prescribe the fentanyl product Subsys. The drug went on the market in 2012, supposedly to treat cancer-related pain, and was competing against at least four other fentanyl products.
About three minutes into the video, a purple-and-white Subsys bottle with a label marked 1,600 micrograms — the maximum dosage for the under-the-tongue spray — appears in a playground where the salesmen are rapping. The bottle then joins the duo, who go by the names Z Real and A Bean.
The refrain in the song — inspired by the rapper A$AP Rocky — is, “I love titration, yeah that’s not a problem. I got new patients, and I got a lot of ’em.” Titration refers to adjusting the dosage of a drug.
The video ends when the rapper in the Subsys bottle removes the costume, flexes his arms, and whoops around. It turns out to be Alec Burlakoff, who at the time was Insys’s hard-driving vice president of sales.
Prosecutors say Burlakoff was a driving force in the alleged conspiracy to get doctors and other practitioners to prescribe Subsys by plying them with illegal payments. He pleaded guilty to a count of racketeering conspiracy in November and is expected to testify against the defendants.
The video marked the latest remarkable moment in the trial, which has featured almost three weeks of testimony. Earlier, a former sales representative testified that one of the defendants, Sunrise Lee, a regional sales director and former stripper, performed a lap dance for an Illinois physician at a nightclub to induce him to prescribe more Subsys.
The jury saw the video on the second day Michael Babich was on the stand. Babich served as Insys’s chief executive from 2011 to late 2015. He pleaded guilty last month to conspiracy to commit mail fraud and wire fraud, and to mail fraud. He, too, has cut a deal with prosecutors.
Babich testified that he sat next to Kapoor in the back row of a room when the video was played at a national sales staff meeting, but he gave few other details.
Earlier Wednesday, Babich testified that he felt the company “owned” several doctors who had received thousands of dollars from Insys to prescribe Subsys, and he didn’t want them to prescribe other competing fentanyl products.
Under questioning by Assistant US Attorney K. Nathaniel Yeager, Babich reviewed dozens of Insys e-mails that have been entered into evidence. He said high-ranking executives at Insys painstakingly identified doctors around the country who had a history of prescribing opioids, then wooed those physicians and funneled what he called bribes to them through a sham speakers program.
Almost every weekday morning at 8:30, he said, Kapoor, Babich, Burlakoff, and other key executives got on a conference call and reviewed how many prescriptions the doctors were writing, and at what dosages, to determine whether Insys was getting a good “return on its investment.”
The Insys executives wanted doctors to not only write a lot of prescriptions, Babich said, but to prescribe higher doses because it meant more money for the company.
Although the Food and Drug Administration had approved Subsys to treat cancer-related pain, prosecutors say that most of the recipients didn’t have cancer. Prosecutors say Insys helped doctors who were big prescribers mislead insurers into thinking that patients actually had cancer when they didn’t. Sometimes, prosecutors say, Insys employees put doctors’ staffers on the drug firm’s payroll to get those workers to persuade insurers to cover the cost of Subsys.