California: Drugmaker paid doctors to overprescribe Humira

Humira is an injectable drug that is widely advertised as a treatment for rheumatoid arthritis and other inflammatory conditions, and comes with a warning for cancer and serious infections that can turn deadly. AbbVie operates in compliance with the many state and federal laws that govern interactions with healthcare providers and patients ... During that time, private insurers processed more than 274,000 claims for coverage of Humira treatment for California patients, paying out almost $1.3 billion.

Insurance Commissioner Dave Jones on Tuesday sued the drugmaker in Alameda County, alleging that nurses hired by the company to meet with patients provided misinformation about Humira and kept complaints about the blockbuster drug from getting back to doctors.

Much of the lawsuit covering the alleged "classic kickbacks" paid by AbbVie to doctors is redacted. Suarez trained nurses who visited Humira patients around the USA, although these nurses also accompanied AbbVie sales reps on visits to physician offices.

Jones said those practices suggest that California insurance companies may have paid claims for Humira for patients who should not have been prescribed the drug in the first place, causing harm not only to patients but also to all California insurance ratepayers.

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. It represents the largest health insurance fraud case ever filed by the department, which.

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"AbbVie spent millions convincing patients and health care professionals that AbbVie Ambassadors were patient advocates".

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. According to the suit, Suarez became aware of the nationwide reach of AbbVie's nurse network because his success as an Ambassador led him to a role as a trainer of other staff. Instead, the nurses employed through the program were allegedly instructed to keep patients on Humira and refer questions and concerns to AbbVie, not physicians.

"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", AbbVie said in a statement.

"While Suarez initially took the job as an Ambassador to help care for patients with challenging diagnoses, says the suit, he later "...felt that the focus of the Ambassador program was getting and keeping patients on Humira to maintain and increase AbbVie's profits".

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

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