California Department of Insurance fraud lawsuit results in reforms of HUMIRA marketing and $24 million payment by drugmaker AbbVie
News: 2020 Press Release
OAKLAND, Calif. — Insurance Commissioner Ricardo Lara today announced a settlement agreement with AbbVie Inc. to resolve a lawsuit alleging violations of the California Insurance Frauds Prevention Act (Act) involving the marketing of blockbuster prescription drug HUMIRA. AbbVie agreed to reform its HUMIRA marketing practices in California, including disclosing that registered nurses employed as “Ambassadors” to interact with patients about HUMIRA are actually paid by the company, not a medical provider, and reforming how HUMIRA is marketed to health care providers. In addition, as provided for in the Act, AbbVie has also paid a combined $24 million to the State of California and the whistleblower who brought the case to the Department’s attention.
"AbbVie's prior practices in marketing HUMIRA egregiously put profits ahead of transparency in patient care and violated California law," said Commissioner Lara. “This settlement delivers important reforms to AbbVie's business practices and a substantial monetary recovery that will be used to continue to combat insurance fraud."
In October 2016, the Department began an investigation into AbbVie after recieving a whistleblower case filed by a registered nurse who was employed as an AbbVie Ambassador in Florida. After its investigation, the Department intervened in that case and filed a Superseding Complaint alleging that whistleblower violated California’s Insurance Frauds Prevention Act. Among other things, the Department alleged that AbbVie violated the Act by unlawfully providing free and valuable professional goods and services to physicians to induce and reward AbbVie prescriptions. The Department alleged that Nurse Ambassadors interfered with the flow of doctor-patient communications and did not directly answer questions pertaining to AbbVie marketing activities constituted kickbacks in violation of the Act, including, for example, the provision of meals and drinks to providers outside the context of speakers programs.
While AbbVie continues to deny the allegations, as a part of the settlement, AbbVie agreed to reforms, including:
- Ambassadors will disclose to patients that they are provided by AbbVie and do not work under the direction of the patient’s health care provider.
- The company will implement a policy modification prohibiting HUMIRA sales representatives from inviting HUMIRA prescribing health care providers to offsite business meals, except as part of the AbbVie speaker programs.
- AbbVie will provide patients with the U.S. FDA-approved HUMIRA medication guide and Ambassadors will direct patients to the medication guide and their health care provider regarding side effects and safety risk.
- The company will provide guidance and training that Ambassadors shall not have patient-specific discussions with providers who prescribe AbbVie.
- AbbVie employees will be prohibited from describing Ambassadors to health care providers as “extensions of their offices” and from providing to providers any contact information for Ambassadors who interact with HUMIRA patients.
- AbbVie employees and Ambassadors will not actively participate in conversations between patients and insurance companies.
The complete list of AbbVie's business practice reforms can be found in the settlement.
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- The settlement agreement can be found here.
- Insurance Frauds Preventions Act Allocation Agreement can be found here.
- This lawsuit and resolution applies to the case filed in Alameda Superior Court (Case No. RG18893169) which alleges violations of the Insurance Frauds Prevention Act. There is a seperate case pending (Suarez et al v. AbbVie Inc) in the Northern District of Illinois that alleges violations of the Federal False Claims Act and various state false claims acts. The Commissioner is not a party to that litigation.
- The non-monetary terms discussed in this release only apply in California.
Led by Insurance Commissioner Ricardo Lara, the California Department of Insurance is the consumer protection agency for the nation's largest insurance marketplace and safeguards all of the state’s consumers by fairly regulating the insurance industry. Under the Commissioner’s direction, the Department uses its authority to protect Californians from insurance rates that are excessive, inadequate, or unfairly discriminatory, oversee insurer solvency to pay claims, set standards for agents and broker licensing, perform market conduct reviews of insurance companies, resolve consumer complaints, and investigate and prosecute insurance fraud. Consumers are urged to call 1-800-927-4357 with any questions or contact us at www.insurance.ca.gov via webform or online chat. Non-media inquiries should be directed to the Consumer Hotline at 800-927-4357. Teletypewriter (TTY), please dial 800-482-4833.