In the US, the Doctors of Sanofi are “Expensive”

In the US, the Doctors of Sanofi are ExpensiveIt is a doctor of Augusta, a small town in Georgia, the United States, who holds the record. Hundred twelve thousand five hundred and twenty dollars: this is what Dr Charles Schaefer pocketed over the last five months of 2013 from Sanofi, including nearly 24,000 dollars to promote its star insulin, Lantus. Extrapolated over an entire year, this makes a check for more than… 270,000 dollars! Half of the amount paid by the French pharmaceutical giant is consulting assignments and a quarter pays public interventions. Travel expenses and accommodation are a budget of more than $25,000.

These figures come from a huge public database, online since October 1, which lists all amounts paid by laboratories to physicians in the United States. Financial ties previously kept secret. It shows that to boost sales of Lantus – a “blockbuster” that earned the company more than $7.5 billion in 2013 but was threatened by the arrival of generics – Sanofi did not hesitate to get out the checkbook.

The most zealous received more than 15,000 dollars

Twenty GPs of the established reputation – including Dr Schaefer – thus received 65,000 dollars between August and December for the “promotion” of Lantus to help the group build its sales pitch. They received between 1.310 and 3.230 dollars per “speech” (at conferences or seminars) and between 2.190 and 4.440 dollars for each mission of “consulting”. The most zealous, like James Randy Long, who practices in North Carolina, or Dennis Deruelle in Tampa, Florida, received more than 15,000 dollars. In total, Sanofi paid $9.5 million to US doctors over the last five months of 2013 (22.8 million over the year by extrapolating). A figure from the database “Open Payments”, posted by the CMS, the American equivalent of health insurance.

The profitability of the investment, however, is one of the highest. The influence of doctor peers is much more critical than that of a commercial. And the trick also works with the authorities, including the powerful American Drug Agency (FDA).

For example in November 2012, at a meeting focusing on Tresiba, insulin developed by Novo Nordisk to compete with Lantus and authorized recently. Among the “auditors” who can give their opinion without being part of the expert panel, we find Riccardo Perfetti, in charge of medical affairs of the Diabetes Division Sanofi. But also… Dr Charles Schaefer, whose financial ties to the firm are not specified.

Complaint from a former employee

In 2011, Sanofi was pinned by the US Senate for using this type of strings. To protect its Lovenox, an anticoagulant which, as Lantus today, was about to lose its patent, the lab had used “false nose” to push its case to the FDA and delay the arrival of a generic.

Dr Victor Tapson, who had received from Sanofi 260,000 dollars, had written a letter asking the FDA to consider the evidence presented at a “scientific round table” organized in California… and sponsored in the sum of 190,000 dollars by the French group. Society Hospital Medicine (SHM) and the North American Thrombosis Forum (NATF), two medical associations told the agency that a generic “was not in the best interest of patients”, without specifying their financial relationship with Sanofi. The first had received $2.6 million from the laboratory, and the second $2.3 million.

The group has always denied the existence of a “skeleton in the closet”

Sanofi refused to answer questions about its financial ties with some handpicked doctors. But on December 3, a former employee of Sanofi, Diane Ponte, filed a complaint in the US against her former employer, accusing it of paying $34 million of bribes to doctors, pharmacies and hospitals to emphasize its antidiabetic rather than its competitor Levemir Novo Nordisk. Both laboratories are engaged in a merciless price war to convince the powerful pharmacy benefit managers, who negotiate drug prices for about 20% of the 4 billion prescriptions written annually in the United States.

The complaint filed in New Jersey cites several leaders of the group, including the former CEO of Sanofi, Chris Viehbacher, against all odds expectations fired in late October. The group has always denied the existence of a “skeleton in the closet”, but the multiplication of departures within its US subsidiary are surprising. Bob Rossilli, sales of the diabetes division at Sanofi in the United States, left the laboratory on November 17, as Raymond Godleski, one of the leaders of “special projects”. In January, Dennis Urbaniak, Vice President of the same division, had preceded them. He was previously head of marketing… for Lovenox, the drug at the heart of the Senate inquiry.

He has since joined Accenture, the consulting company which, according to Diane Ponte, served as a screen for illegal payments from Sanofi. Deloitte is also its competitor in this matter. “According to my information, Sanofi has conducted an internal investigation on this subject, but its findings have remained secret,” said the World Rosemarie Arnold, counsel for Diane Ponte. “My investigators that had started inquiring two weeks before the filing of the complaint, are in the process of bringing together all the elements for a trial,” she added.

Disgruntled shareholders

And now the latest sword of Damocles over the head of the laboratory: since December 4, it is covered by a group action (or class action) from disgruntled shareholders that collectively lost $22 billion, as a result of the collapse of the stock exchange. They accuse Sanofi of having concealed important financial information as well as corruption. “The group’s statements [about the results] are wrong and misleading because a significant portion of the Company’s revenues derived from illegal activities”, it is stated in the complaint, which cites the names of Chris Viehbacher and Jérôme Contamine, the financial director of the laboratory.

The 19-page document recalls that in 2012 Sanofi had to pay $109 million to escape a corruption trial. According to the results of the investigation, the laboratory would have provided free of charge to physicians thousands doses of Hyalgan, a drug indicated for the treatment of arthritis. An illegal practice whose purpose was to delay the spread of treatment of a cheaper competitor. In its ruling, the US Department of Justice cited the case of Sanofi California representatives providing 25 free samples per hundred to buy Hyalgan boxes, accompanied by sumptuous dinners for doctors at the expense and with the agreement of the group.

Regarding the group action, Sanofi said it had “intention to [be] vigorously defensive against these claims, and issue [a] no further comment.” As to the complaint filed on December 3 by its former employee, Diane Ponte, the pharmaceutical group states: “Diane Ponte is a former disgruntled employee who opportunistically attacks our society. Ms Ponte filed a complaint for violation of labor law in the State of New Jersey, and more specifically the New Jersey Conscientious Employee Protection Act (CEPA). The allegations about the labor law are unfounded and Sanofi will vigorously defend itself. We take this matter very seriously and intend to protect our company and our reputation.”

“This is pocket money,” says a doctor

Dr James Randy Long is the only one to have readily agreed to speak. Over the last five months of 2013, he pocketed just over 15,000 dollars from Sanofi to “educate” his peers at the management of diabetes. He started working for the French laboratory about six years ago, by chance. “My name came to them by word-of-mouth,” he says.

Since then, he gives one or two “speeches” a month before an audience of 20 to 30 participants. “The invitations are by trade. They generally target an establishment where Lantus is anticipated by the Levemir, concurrent insulin made by Novo Nordisk,” said the doctor, not fooled by Sanofi objectives but convinced by the superiority of Lantus. “I only use Levemir that if I am forced by insurance,” he says.

Once a year, he was invited to a debriefing by Sanofi in Chicago. The 300 members of the “Speakers Bureau” as they are called, are invited to give their opinions on the products and provide advice on how the group could better “communicate” with doctors and “help to make better job.” He knows that “laboratories marketing mainly relies on good relationships with physicians.” But, he said, it is also beneficial to physicians. “You have to keep abreast of what is happening. This does not prevent physicians from doing their own research,” he added, regretting being considered by some of his peers as a travelling salesman.

A firm that conducted with more of “ethics”

His motivation is not financial, he said. “This is pocket money, he insists. This compensates just what I lose in absenting from my office.” A good speaker, he finds this exercise “amusing”. He said the firm is rather less “aggressive” than its competitors and operating with more “ethics.”

The company is certainly the big winner in the deal, both in terms of influence in business. Data from Prescriber Checkup, a tool developed by journalists ProPublica, which analyzes public data limitation the US, reveal that doctors paid to promote Lantus are also those who prescribe the most. Lantus is at 36th place medication prescribed by Dr Long, while this is only about 51st insulin on average with other internists.

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