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P A G E | 1

FUELING AN EPIDEMIC 

Inside the Insys Strategy for Boosting Fentanyl Sales 

EXECUTIVE SUMMARY

During the height of the prescription opioid crisis in the United States, Insys 

Therapeutics, Inc., adopted and intensified sales and marketing techniques Purdue 

Pharma pioneered in the 1990s for OxyContin and applied them to Insys’ powerful 

fentanyl drug Subsys. Like Purdue, Insys aggressively used speakers programs—in which 

the company paid physicians to discuss Subsys with colleagues—and compensation 

programs for sales representatives to boost sales for Subsys. 

Based on a review of 1.6 million pages of internal Insys documents provided in 

response to March 2017 requests from Ranking Member McCaskill, this report discusses

how the interplay between compensation—for physicians on the one hand and their 

assigned sales representatives on the other—drove explosive growth for Insys. 

Alongside speakers programs, Insys also established several other sales and marketing 

practices that formed the core of its approach to boosting Subsys sales: bonus

structures for sales representatives that rewarded high-dosage prescriptions, 

accountability for representatives who failed to generate sufficient scripts, and the 

leveraging of personal relationships between physicians and representatives. Uniting 

these efforts, as an Insys national sales director wrote in 2013, was a simple idea: ‘What 

drives us all? COMPENSATION.

In connection with these policies, Insys executives emphasized the importance of 

“owning” a physician—meaning that sales representatives should tightly monitor and 

control prescribing behavior—as well as the “return on investment” the company 

expected from speakers programs. Similarly, company managers referred to Subsys 

patients as representing “annuities” for sales representatives. Using slogans like 

“Strength Makes the Difference” and “Don’t Forget the Doses,” Insys executives also 

reminded representatives that strong Subsys dosages yielded higher bonus payouts. 

And managers encouraged representatives to “hold the customer accountable” when 

physicians and nurses failed to sustain or increase Subsys prescriptions—in part by 

leveraging personal relationships with these prescribers. 

This report also highlights the examples of Heather Alfonso, a nurse practitioner 

from Connecticut, and Dr. Steven Simon, a physician practicing near Kansas City, 

Missouri—two practitioners separated by geography but united in their high Subsys 

prescribing and receipt of substantial payments from Insys. These case studies

demonstrate exactly how company executives motivated sales representatives to 

“own” physicians through promises of compensation for both sides—and how these 

efforts in turn significantly affected patient treatment.
P A G E | 2

At the same time, Insys knew as early as 2014 that the company’s speakers 

programs suffered from serious deficiencies. According to a report an outside 

consultant drafted for the company in February 2014, compliance issues with these 

programs included an absence of safety content, no clear disclosure of Insys 

sponsorship, and in at least one case, a guest list that indicated the program lacked a 

true educational purpose.

In correspondence with the Committee on September 1, 2017, new Insys CEO 

Saeed Motahari emphasized his concern over previous “unacceptable actions of 

former Insys employees” and stated that “the company has taken necessary steps to 

ensure that we will not repeat the mistakes of the past.”1 Insys, for example, “has 

completely transformed its employee base,” replacing key managers and overseeing 

the departure of “over 90% of the 250 field-based sales staff employed prior to 2014.”2 

In general, according to Mr. Motahari, the company “has actively taken the 

appropriate steps to place ethical standards of conduct and patient interests at the 

heart of our business decisions.”3 In August 2018, the company announced it had 

reached a $150 million settlement to resolve a Department of Justice investigation into 

its sales practices.4 

 

Although Insys has discontinued speakers programs for Subsys, the success of its 

policies ensures the industry-wide threat of physician payments affecting the volume 

and strength of prescriptions will continue. Just as Insys adopted and expanded 

methods Purdue pioneered, the next pharmaceutical company moving rapidly to 

establish market share in a crowded field may look to Insys as a model. This report

represents a warning to policymakers seeking to prevent actors in the pharmaceutical 

industry from fueling the next public health crisis. 

INTRODUCTION

Since the 1990s, the volume of opioid prescriptions dispensed in the United States 

has grown dramatically, along with the number of Americans suffering from opioid use 

disorder and the number of fatal drug overdoses involving opioid products.5 An 

increase in chronic pain in the U.S. population cannot serve—alone—as an adequate 

explanation for this epidemic. A slide from an internal Depomed, Inc., presentation 

from October 2016, arguing for the need for opioid prescribing guidelines, states it 

plainly: “Prescription opioid sales in the United States have increased by 300% since 

1999 without a commensurate increase in the amount of pain.”6 

One explanation for the explosion in opioid use in the United States points to the 

sales and marketing techniques Purdue Pharma pioneered for the introduction of 

OxyContin in 1996.7 As Dr. Andrew Kolodny of Brandeis University has explained, “[i]f 

you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing

really takes off ... It’s not a coincidence. That was the year Purdue launched a 

multifaceted campaign that misinformed the medical community about the risks [of 

OxyContin].”8 As part of this campaign, Purdue employed “speakers programs”—in 

which the company paid physicians to discuss OxyContin with their colleagues—to 

boost sales of the drug. Along with sales representatives, physicians received all-
P A G E | 3

expenses-paid vacations to “pain management seminars” in resort locations like Boca 

Raton, Florida, and Pebble Beach, California.9 According to Purdue records, physicians 

attending speaker training seminars issued more than twice as many OxyContin 

prescriptions as non-attendants.

10

 At the same time, Purdue set aggressive quotas for 

sales representatives, premised on the concept of “sell or be gone,”11 and established 

lucrative bonuses for higher dosages of OxyContin.12 (As one Purdue manager 

allegedly wrote in 1996, “[h]e who sells 40mg”—the largest dose then available—“will 

win the battle.”13) 

This interplay between compensation—for physicians on the one hand and their 

assigned sales representatives on the other—drove explosive growth. By the fifth year 

of OxyContin sales, the drug generated more than $1 billion in annual revenue for the 

company.14 In 2001 alone, “Purdue paid $40 million in sales incentive bonuses to its 

sales representatives.”15 The same year, annual bonuses for Purdue sales 

representatives averaged $71,500—compared to the average salary of $55,000—with a 

bonus range of $15,000 to almost $240,000.16 

In late 2016, Purdue announced the end of its speakers programs for 

OxyContin,17 and in February 2018—days before the release of the Homeland Security 

and Governmental Affairs Committee minority staff report entitled, “Fueling an 

Epidemic: Exposing the Financial Ties Between Opioid Manufacturers and Third Party 

Advocacy Groups”—the company announced it would end all efforts to promote 

opioid products directly to physicians.18 

Speakers programs and other payments to physicians represent an effective 

means of changing prescribing practices in general, and recent research also shows 

the same trend applies for opioids. A June 2018 study of payments to New York doctors

found, for example, that “physicians who received payments from opioid 

manufacturers had higher opioid prescribing to Medicare patients than physicians who 

did not receive any opioid-related payments.”19 According to a May 2018 research 

letter in JAMA Internal Medicine, “[o]f physicians who prescribed opioids under 

Medicare Part D, 7.0% received nonresearch payments related to opioid products in 

2014,” and these payments “were associated with greater opioid prescribing in 2015.”20 

Similarly, a March 2018 analysis of Medicare prescribing from CNN and Harvard 

University found that “the more opioids a doctor prescribes, the more money he or she 

makes.”21 Among the physicians in the top tenth of 1% of opioid prescribers by volume, 

95% received payments from opioid manufacturers, and these physicians received nine 

times as many payments as physicians with median prescription volumes.

22

 In addition, 

a 2018 investigation by CareDash Analytics “found that physicians receiving payment 

on behalf of an opioid were 14.5 times more likely to choose that drug over its 

alternatives in the same year.”23

Like Purdue, Insys Therapeutics, Inc., aggressively used speakers programs, 

physician detailing, bonus structures, and management pressure to boost sales for its 

fentanyl product Subsys. Between 2012—the year the Food and Drug Administration 

approved Subsys24—and 2013, Insys achieved more than 1,000% growth in net revenue 

from Subsys sales.25 Following multiple federal investigations, indictments—including for 

Insys founder and former CEO Dr. John Kapoor—and whistleblower complaints, the 
P A G E | 4

company reduced speakers programs between 2015 and 2017 before ending the 

practice altogether.26 At the same time, former Subsys patients have continued to 

struggle with the lingering effects of excessive or unnecessary fentanyl treatment. At a 

roundtable event hosted by Ranking Member McCaskill in September 2017, for 

example, Jeffrey Buchalter, an Army veteran, described how he suffered serious 

physical injury from the overprescription of Subsys.27 His physician, Dr. William Tham, 

received approximately $50,000 in payments from Insys between 2014 and 2016.28 

Drawing on over 1.6 million pages of documents provided in response to March 

2017 requests from Ranking Member McCaskill, this report examines Insys sales and 

marketing practices through internal company reports, presentations, and 

communications. The sections below also highlight the cases of Heather Alfonso, a 

nurse practitioner from Connecticut, and Dr. Steven Simon, a physician practicing near 

Kansas City, Missouri—two practitioners separated by geography but united in their high 

Subsys prescribing and receipt of substantial payments from Insys. These examples 

demonstrate how company executives motivated sales representatives to “own” 

physicians—through promises of compensation for both sides—and how these efforts in 

turn significantly affected patient treatment. 

 

THE INSYS MODEL

Faced with lackluster initial sales of Subsys in 2012, company founder Dr. John 

Kapoor and CEO Michael Babich worked with Insys sales executive Alec Burlakoff to use 

speakers programs to boost prescription volume.29 As the New York Times has 

explained, these “programs are a widely used marketing tool in the pharmaceutical 

business. Drug makers enlist doctors to give paid talks about the benefits of a product 

to other potential prescribers, at a clinic or over dinner in a private room at a 

restaurant.”30 Alongside speakers programs, Insys also established several other sales 

and marketing practices that formed the core of its approach to boosting Subsys sales: 

bonus structures for sales representatives that rewarded high-dosage prescriptions, 

accountability for representatives who failed to generate sufficient scripts, and the 

leveraging of personal relationships between physicians and representatives. Uniting 

these efforts, as National Director of Sales Richard Simon wrote to district sales 

managers in October 2013, was a simple idea: “What drives us all? COMPENSATION.”31 

Because of these efforts, Subsys prescribers often appeared as outliers among 

their peers in terms of opioid claims and the cost of the opioids they prescribed. In the 

Medicare Part D program in 2015, for example, 33.4% of Subsys prescribers generated 

more than 2,500 opioid claims, compared to 3.3% of fentanyl prescribers and 0.4% of 

opioid prescribers generally.32 Similarly, almost 20% of Subsys prescribers generated 

more than $1 million in total opioid costs in Part D in 2015, compared to less than 1% of 

both fentanyl prescribers and opioid prescribers generally.33 The sections below discuss 

how the interplay between the complementary financial motives driving sales 

representatives and physicians achieved these results. 
P A G E | 5

A. Speakers Programs and Compensation for Physicians

Speakers programs formed the centerpiece of Insys efforts to influence physician 

behavior and boost prescriptions of Subsys. Internal Insys documents produced to the 

Committee confirm the importance of speakers programs to company sales and 

marketing efforts. Mr. Burlakoff, for example, stated in an October 2013 email to district 

and regional sales managers that “my personal feeling is that Insys speaker programs 

are the single most important thing we have the luxury of doing here in order to 

promote our product. [...] Although our sales organization is well educated, nothing is 

more powerful that [sic] a physician’s lecture to his or her fellow physicians.”34 Mr. 

Burlakoff also noted that when interviewing sales representatives, “you need to explain 

that their single most important function will be facilitating speaker programs.”35 

Regarding current sales representatives, Mr. Burlakoff explained that “[i]f you determine 

that they are not doing more programs now than ever before; because they can’t fulfill 

their administrative responsibilities—they must be terminated from Insys.”36 Similarly, Mr. 

Burlakoff stated to all Insys sales personnel in April 2013:

ISP’s [Insys speakers programs] are the most important thing you will do to 

increase your business. ISP’s are basically the ONLY thing you should be 

focusing on to increase your sales. [...] Most of you say you want to 

work, say you want to make money, but don’t put forth the necessary 

effort pertaining to ISP’s to back up what you say. [...] If you are not 

living, eating, and breathing ISP’s to drive sales, you should not be in 

specialty pharma.37 

Several central concepts guided the Insys approach to speakers programs. First, 

multiple Insys communications emphasize the importance of “owning” a physician—

meaning that sales representatives should tightly monitor and influence prescribing 

behavior. In an October 2012 email providing guidance to sales representatives, Frank 

Serra, the Northeast Regional Sales Manager at the time, tellingly describes physicians 

as “customers,” explaining that “[b]y hold[ing] the customer accountable to which 

patient they will prescribe for, keeps THEM focused. By letting them know you’re 

standing right by them watching, keeps them committed.”38 In response, Mr. Burlakoff 

concurs, telling Mr. Serra, “[g]reat e-mail, we are most definitely on the same page....”

39

 

Mr. Serra echoed the language in a subsequent email the same month, recounting that 

when a sales representative “looked up the data, she noted that [a prescriber] hadn’t 

written as much Subsys as he told her!! Needless to say, [the representative] was right 

there in his face. Talk about accountability.”40

Similarly, in a December 2012 email to regional sales managers, Mr. Burlakoff 

dismissed excuses from representatives related to the upcoming holidays, noting that 

“[h]olidays never hurt the representatives whom [sic] OWN five doctors.”41 Regarding 

underperforming representatives, Mr. Burlakoff stated: “They failed—because [they] 

neglected to listen. They did not put in the work to own their physicians over the past 9 

months, and now they are blaming it in [sic] the ‘holidays.”42 
P A G E | 6

Months later, in March 2013, Mr. Burlakoff similarly noted to Insys sales 

representatives that the five representatives “at the top of the company rankings—

literally have their entire business being driven by basically 1 customer. This is NOT luck 

and it is not due to any special advantage these sales people have been given. [...] 

They found a customer to ‘own,’ and they packed the proverbial suitcase and moved 

in.”43 (The high cost of Subsys allowed a relatively small number of prescribers to sustain 

company revenues. The “Strategic Imperatives” slide of an Insys presentation entitled, 

“2014 SUBSYS Marketing Planning,” for example, states that “[t]he core group of 

prescribers must be nurtured and protected. With a relatively small number of core 

prescribers, we must maintain their current business and seek additional opportunity.”44) 

Mr. Burlakoff closed his email by urging representatives to “[o]wn your territory—own a 

doctor—and own your destiny.”45 

Second, internal Insys documents repeatedly emphasized the “return on 

investment” the company expected from speakers programs. An Insys presentation 

titled, “2013 Proposed Marketing Budget,” for example, features a chart showing a 

sharp spike in Subsys prescriptions in 2012 at the same time as an upward “trend line 

inflection” in the number of speakers programs.46 The same presentation includes an 

“ROI Assessment” explaining that “[s]peakers with programs generated ~6Xs more 

revenue per prescriber than those with no programs” and noting a “7.5:1 ROI” based 

on a comparison of honoraria to speakers to net revenue and a 5:1 return on 

investment based on a comparison of total speakers program expenses to net 

revenue.47 Later in the presentation, a slide states that speakers with “ROI less than 2:1” 

have been “flagged.”48 Similarly, another slide states that “all Regions with low ROI” 

have been “flagged.”49 

According to a slide in an Insys presentation titled, “2014 Proposed Marketing 

Budget,” physicians “who attend multiple [Insys speakers programs] are more prolific” 

prescribers—with an average of 8.61 prescriptions from physicians who attended one 

program compared to 17.63 prescriptions from physicians who attended more than 

one program.50 Based on data from 2012 through March 28, 2013, the slide also stated 

that 207 physician participants (or 30% of attendees) wrote at least one prescription for 

Subsys, with an average of $37,260 in revenue and 13.43 prescriptions per participant.51 

Within this category, moreover, 42% of physicians “did not write a [prescription] until 

after their first [Insys speakers program]” and the average time between a program and 

a prescription was 95 days.52

Communications to the Insys sales force also suggest the company clearly 

recognized a direct connection between payments to physicians in speakers programs 

and Subsys prescribing. In fact, in an email reviewed by the minority staff, Mr. Burlakoff 

asked a fellow Insys sales executive, “[w]hy are we allocating money to each rep for 

[speakers] programs. Half of your reps do not produce, why give them program 

dollars? [...] I am tired of giving money to reps whom [sic] produce zero return on 

investment. The majority of your reps produce sales, but do they all produce ROI as it 

pertains to programs? Those whom [sic] do not produce ROI from programs should not 

be spending our ISP dollars.”53 Mr. Burlakoff noted in closing that “I need the reps whom

[sic] can get the most bang for their buck using our money.”54 District sales manager 

Jonathan Roper echoed this language in an email to sales representatives, asking: 
P A G E | 7

“Where is the ROI??!!! [...] We hire only the best of the best to be apart [sic] of our 

speaker bureau and dropping script counts is what we get in turn? [...] Time for your 

main guys to step it up and give you the ROI you deserve.”55 Underscoring this point in 

an email to sales representatives, regional sales manager Jeff Pearlman included a 

sample presentation for representatives to use when describing their “opportunities” 

and “threats”; one of the sample threats listed was “No ROI from speaker programs.”56 

At the other end of the spectrum, Insys documents show that when physicians 

met prescribing expectations, additional speaking opportunities followed. In one case, 

a sales representative informed a prescriber: “They see you’re prescribing and gaining 

clinical experience with Subsys, so I asked for more [speaker] programs asap – it worked 

:).”57 

Insys knew as early as 2014 that speakers programs presented serious 

compliance challenges even as they produced dramatic results. According to a report 

dated February 25, 2014, Insys asked Compliance Implementation Services, LLC (CIS) to 

monitor 15 speakers programs in the fourth quarter of 2013—“to provide assistance in 

meeting the on-going challenges in sustaining compliance” in these programs.58 CIS 

later summarized certain compliance issues with nine speaker programs its 

representatives had monitored. In one summary, for example, CIS noted that “the 

presentation was severely lacking in content delivery of safety information.”59 In 

another case, “[s]afety information was not discussed at all during the presentation”—

and troublingly, “there was no clear disclosure to the attendees that the program was 

sponsored by INSYS.”60 Similarly, during another program, “the INSYS Sales 

Representative introduced the speaker and informed the attendees that the Speaker 

[would] be providing further information on the SUBSYS® product...[h]owever, there was 

no clear disclosure to the attendees that the program was sponsored by INSYS.”61 The 

speaker also provided “anecdotal information regarding a patient with back pain for 

which SUBSYS® was effective; however, it is unclear if the patient is an adult cancer 

patient.”62 The speaker also “spent a minimal amount of time discussing safety 

information”63; a detailed checklist describing this program further stated that the 

speaker “noted that he was not aware of any incidents that have resulted in death for 

patients that have utilized SUBSYS.”64 Finally, in an indication that certain speakers 

programs lacked a true educational purpose, one speaker program checklist notes 

that “[a]part from CIS, and INSYS rep, all attendees were from the speaker’s office.”65

B. Compensation for Sales Representatives 

As with their physician counterparts, Insys sales representatives received 

significant financial incentives to boost the number and strength of the Subsys 

prescriptions they generated. To motivate sales representatives, Insys allegedly 

implemented a compensation structure with a low base salary and high commissions 

and rewards for “the achievement of certain goals known to the company to increase 

off-label Subsys prescriptions.”66 In 2016, an external consulting firm informed Insys 

executives that this “incentive compensation structure was troubling because it 

incentivized non-compliant behavior and was ‘way outside the norm.’”67 During 

interviews with the firm, Insys employees admitted “that they themselves found that 

Insys’s ‘compensation structure encouraged inappropriate behavior,’ which [one 
P A G E | 8

executive at the company] assumed to mean ‘off label promotion and quid pro quo 

behavior.’”68 

Mr. Burlakoff clearly outlined the financial incentives for sales personnel to meet 

company goals in an email in March 2013, writing that “[w]e expect at minimum we 

each grow our territory by 25 percent in the uncapped bonus plan I just sent. The faster 

you get to 100K, the faster your earnings will grow. We need to start fast out of the gate 

Monday to ensure our goal of almost 20 million is hit. The top rep earned over 90K this 

quarter, who else wants some of that???”69 He later noted in March 2014 that the 

lowest-ranked representatives made “20k a quarter plus a 40k base which equals 140K 

for only maintaining the base of business. This is ridiculously unheard of in the industry—

BUT TRUE FOR INSYS!”70 

Bonuses for representatives also varied significantly based on the Subsys dosage 

prescribed—with higher doses yielding higher payouts. According to a Subsys Incentive 

Compensation Plan for Q2 2013, for example, “[h]igh dose (1200 and 1600MCG 

[micrograms]) still gets the highest payout rate.”71 Similarly, a slide presentation entitled, 

“SUBSYS Incentive Compensation Plan Q4 2013” noted that for specialty sales 

professionals who started with Insys before the second quarter of 2013, bonus payouts 

of 5% applied to prescriptions with doses of 100-800 mcg and 7.5% bonus payouts 

applied to prescriptions with doses of 1200-1600 mcg.72 For specialty sales professionals 

starting during or after the second quarter of 2013, the bonus payouts for these doses 

amounted to 7% and 10%, respectively.73 

As CEO Michael Babich noted in a June 2012 email to Insys sales personnel, “you 

will make more money the more units and higher dose you sell. This is never changing 

so continue to discuss with you [sic] writers how to ensure the patient is getting proper 

pain relief. We have heard stories where 800 mcg of subsys [sic] works for some patient 

[sic] that was on 12000 Actiq [a competing fentanyl product] and we have heard 

others says [sic] it isn’t strong enough in this scenario.”74 (Mr. Babich did note, however, 

that representatives should “encourage your doctor to practice medicine as he or she 

sees fit and to use their clinical judgement [sic].”75) 

In an email from July 2012, Mr. Babich also explained that in a new contest for 

July and August 2012, the top five sales representatives “who have the highest number 

of UNITS written for 600 mcg or higher will receive an extra $1500 and the overall winner 

will get $2000.”76 Similarly, in an email to sales representatives in November 2012, 

Northeast Regional Sales Manager Frank Serra urged Insys employees to push for higher 

doses:

[L]ook at the attached spreadsheet that shows an approximate cash [sic] 

you’ll make when making sure to have the effective dose conversation 

with each target. Note, that at 120 units, there is serious money to be 

made. [...] Every time a doc tells you they prescribed, the very next 

question should be, ‘How Many Units? And What Dose?’ Bang and the 

door is wide open.77
P A G E | 9

The accompanying slide, entitled “Strength Makes the Difference,” shows the 

payouts associated with doses ranging from 100 mcg to 1600 mcg.78 A dosage of 100 

mcg, for example, would yield a payout of $283, while a dosage of 1600 mcg would 

yield a significantly larger payout of $1,830.79 The slide also notes that a 10% bonus 

payout applied for 100 mcg-800 mcg scripts, while a 12.5% bonus payout applied for 

1200 mcg-1600 mcg scripts.80 

A similar slide entitled, “Don’t Forget the Doses” outlines how bonus payouts 

ranged from $340 per quarter for the 100 mcg version of Subsys to $2,352 for the 1200 

mcg version.81 In a December 2012 email attaching the slide, Mr. Serra was even more 

explicit, stating that “the bigger the script the more money you make. What we used to 

call at my uncle tony’s [sic] beer store, ‘Cash on the Barrel Head.’ Why do you think [a 

sales representative’s] inspection sticker expired, he was making sure a 90/1200 script 

got filled. Now he’ll earn enough to pay off the judge and the DMV!!”82

Insys executives paired this emphasis on high dosages with pressure on sales 

representatives to increase doses for existing Subsys patients, as well as reminders of the 

financial benefits of this “titration” process. In an email dated March 15, 2013, for 

example, Mr. Burlakoff praised a sales representative who “generated an enormous 

script,” noting that “[t]he best part of this entire scenario is the fact that the patient was 

switched from Actiq 1600mcg. The physician has every intention of increasing the dose 

slowly but surely to 1200mcg in an effort to ensure the patient is being titrated 

effectively. Cha Ching again!”83 In an email to sales representatives from November 

2012, Mr. Serra stated that “[i]ts [sic] infinitely easier to get somebody who is Writing to 

Write MORE. We simply need to open the doors.”84 Mr. Serra noted that one nurse 

practitioner “had a patient on 3 of the .25 patches plus Actiq 6x’s a day @1200,” 

adding that “this is a practitioner who is not afraid to titrate, you think?”85 

Mr. Serra’s November 2012 email replied to an email from Mr. Burlakoff that

urged sales representatives to “take specific notice of the number of units per 

prescription your doctor is prescribing. If it is less than 60 per day, your message to this 

doctor should be built around increasing the number of units per day by just 1 unit.”86 

Mr. Burlakoff added:

It is much easier to take an existing patient and double their units (which in 

essence is the same as generating a new prescription)[.] The patient has 

already been through PA process, it is ‘low hanging fruit.’ Be smart and 

work smart, lets [sic] take the existing writers and create a habit of he or 

she using Subsys 4 times a day (as intended) as opposed to the prescriber 

‘sprinkling’ a little Subsys on top of the patient’s current medications. THIS 

IS THE NEXT BIG STEP!87

Extending the concept of “return on investment” for physicians, Insys executives 

also referred to Subsys patients as representing “annuities” for sales representatives. In 

November 2012, for example, Mr. Babich wrote to other top Insys officials to request 

they inform sales representatives of the bonus amounts associated with specific units 

and dosages of Subsys.88 In response, sales operations director Xun (Sean) Yu 

responded with certain bonus amounts and added that Insys executives should “please 
P A G E | 10

see slide attached for ‘patient as annuity.’”89 The attached slide stated that “[a]n 

average patient stays on [rapid onset opioid] therapy for 9-12 months since inception of 

treatment. That’s 3-4 quarters worth of monthly sales to you, an annuity that keeps 

paying.”90 Top performing sales representatives also served as a kind of annuity for the 

company itself; as Mr. Burlakoff explained, “it’s the top 20 percent [of representatives] 

that continues to bless Insys with 80 percent of the company’s growth on a quarterly 

basis.”91 

C. Accountability for Sales Representatives 

Even as Insys executives emphasized to sales representatives the financial 

rewards of increasing prescriptions and dosages, they also clearly outlined the 

consequences of failing to meet these goals. As CNBC has reported, “sales staff were 

under immense pressure, including threats of termination, to get doctors to write more 

prescriptions and higher doses of Subsys for everything from neck pain to migraines.”92 

In an email in September 2012 to sales personnel, for example, Mr. Burlakoff 

explained that under a new policy, Insys sales representatives would “receive an 

email...each and every time a prescriber in your territory writes for a Subsys prescription 

at 100mcg or 200mcg.”93 After receiving notices of low doses, sales representatives 

then needed “to report back within 24 hours on WHY the low dose was used and HOW 

the doctor plans to titrate the patient to effective dose. [...] I know it is not at all easy to 

get a physician to initiate a new habit, and this is exactly what we are attempting to 

do.”94 

Mr. Burlakoff further explained that the intention of the policy was to “help you to 

maintain these newly generated Subsys patients by rapidly informing you of the fact 

that they wrote for a dose and number of units that is simply NOT effective. We are 100 

percent sure that those patients whom [sic] are prescribed 60 units of 100mcg, do not 

end up filling a prescription for Subsys the following month. This is information that we 

feel obligated to share with you, as there is no good at all that comes out of 

withholding the very data that will determine your quarterly bonus payouts.”95 

Moreover, “[t]he goal is to generate Subsys patients whom [sic] believe in the safety 

and efficacy behind this product, hence these patients will continuously refill their 

monthly prescriptions indefinitely. This of course equates to residual income for you!”96 

Mr. Burlakoff further stated that “[w]e must educate our physicians how to ensure their 

patients find the ‘EFFECTIVE DOSE.’ I will go as far as to say that we are truly better off 

dissuading a physician to prescribe Subsys for 100 and 200mcg until we have had 

ample time to review...clinical trial data with them.”97

In a later email to Insys regional sales managers in July 2013, Mr. Burlakoff stated, 

“Fridays, we literally do half in sales as the other 4 days. Every rep that does not 

produce a script two consecutive Fridays will also be placed on a PIP [performance 

improvement plan], considering 1 rx per day has been the goal for over a year.... 

Below is the list that failed to produce this past Friday, if you are on this list you must 

produce 1 single script this Friday to avoid a PIP. All of you are saying ‘what’s with the 

scare tactics,’ that’s no way to motivate a sales force! LET ME BE CRYSTAL CLEAR[.] I’m 
P A G E | 11

not trying to motivate anyone, I am truly trying to get rid of those reps whom [sic] 

choose or simply can’t follow direction.”98

 

D. Leveraging Personal Relationships to Boost Prescriptions

Internal Insys communications clearly show that company executives expected 

sales representatives to leverage their personal relationships with physicians to 

encourage prescribing—with Subsys prescriptions framed as personal obligations 

instead of medical treatments. In a December 2012 email to all sales personnel, for 

example, Mr. Burlakoff urged Insys employees to think about “[w]hat have I done 

different than that of all the other representatives calling on these physicians? [...] How 

do I transition from the doctor viewing me as ‘the Subsys representative’ to ‘Alec—my 

friend in pharmaceuticals?’ Have I really FORCED myself to step ‘outside’ of my 

comfort zone?”99 Mr. Burlakoff continued: “I am 100 percent serious when I tell you, if 

you have not found a way to spend time with your customers OUT OF THE OFFICE AND 

NOT IN A RESTAURANT (its [sic] simply not good enough). [...] If you happen to notice 

one of your doctors on this list...I would sincerely suggest your finding a way to see this 

physician out [of] his or her office.”100 Similarly, district sales manager Jonathan Roper 

advised sales representatives in a February 2014 email to “not be hesitant in asking your 

docs to give you the business in which [sic] you are owed.... [...] If you have a 

relationship, asking this of your docs should be one of the easiest things you do as [a 

specialty sales professional].”101

Communications from the Insys workforce indicate sales personnel adapted their 

behavior accordingly. One sales representative, for example, wrote to Mr. Burlakoff in 

October 2012 that she had met with a physician and potential Subsys prescriber and 

“made plans with him to run together every Monday night at 5 pm. He is looking to get 

back in shape so I told him that I promised i [sic] could help him get to his goal. I am 

sure he will help me get to mine as well:) Thanks for the motivation I am out if [sic] 

finding my go-to doctors.”102 In describing her efforts to convince a physician to 

prescribe Subsys, another representative stated that she had visited the physician “2x a 

month Saturday evenings with my girls at his night clinic. I can tell you everything about 

his family and his personal life. I have invited him to dinner but he is not interested as he 

is over committed [sic] with work.”103

Similarly, in pushing back against pressure to encourage a physician to switch 

from Actiq to Subsys, another representative acknowledged the “huge potential” at 

stake but noted that the prescriber “can not be bought, forced, coerced, bullied, or 

anything else into writing any product. I have lived with [the prescriber] for 10 weeks 

and have developed a great relationship with her. I have met her husband, been 

shown numerous photos of her grandson, invited to her tap classes on Thursday nights, 

and so forth and can tell you that [the prescriber] will be a great advocate for Subsys 

on her own time frame and it will take time.”104 

In keeping with these efforts, Insys executives often framed relationships between 

sales representatives and physicians in personal terms. In an email from December 

2012, for example, Mr. Burlakoff stated: “Quite honestly it always bugs the heck out of 

me when a doctor says how much he loves you, but doesn’t care if you can feed your 
P A G E | 12

family or put gas in your car or buy shoes for the kids. If he loved you, he’s [sic] be 

writing.”105 In another 2014 email to sales representatives, an Insys executive stated, 

“There is no excuse for any of your docs to not take care of you at this critical time of 

the quarter.”106 

CASE STUDIES: HEATHER ALFONSO AND STEVEN SIMON

On June 23, 2015, the U.S. Attorney for the District of Connecticut charged 

Heather Alfonso, an Advanced Practice Registered Nurse and participant in Insys 

speakers programs, with receiving kickbacks in connection with Subsys prescriptions 

under Medicare Part D.107 According to the charging document, from January 2013 

until March 2015, Ms. Alfonso “knowingly and willfully solicit[ed] and receive[d] 

remuneration [of] approximately $83,000, in return for recommending and ordering a 

pain medication [Subsys] used to treat cancer patients.”108

During roughly this same time period, Dr. Steven Simon of Overland Park, 

Kansas—just outside of Kansas City, Missouri—ranked as the eighth-highest paid Subsys 

speaker in the United States.109 According to the CMS Open Payments database, Dr. 

Simon received over $230,000 from Insys between 2013 and 2016.

110

 As the Kansas City 

Star has reported, moreover, Dr. Simon and his nurses “prescribed more Subsys to 

people on Medicare Part D than any other Kansas practitioners.”111 Importantly, 

federal authorities have not charged Dr. Simon with receiving kickbacks or other 

violations, although agents from the Federal Bureau of Investigation reportedly seized 

his patient records in July 2017.112

The experiences of Heather Alfonso and Steven Simon serve as case studies of 

the impact of sales and marketing techniques on opioid prescriber behavior—as well as 

the internal pressures Insys exerted on representatives and other executives to boost 

Subsys use. As shown in Figures 1-8 appended to this report, Ms. Alfonso, Dr. Simon, and 

other Missouri-area Subsys prescribers discussed below placed among the very highest 

prescribers in the Medicare Part D program in 2015 and 2016 by opioid claims, opioid 

costs, fentanyl claims, and fentanyl costs. (Ms. Alfonso ceased prescribing in 2015.) 

Drawing on hundreds of thousands of internal documents produced to the Committee, 

the sections below provide context for these statistics and the behavior of two 

prominent Subsys prescribers. 

A. Heather Alfonso

1. Kickback Allegations

According to statements during her plea hearing in June 2015, Heather Alfonso 

was among the highest prescribers of Subsys in the New England area and 

nationwide.113 In fact, Ms. Alfonso “was responsible for over 1.6 million dollars in Subsys 

claims and was the highest prescriber of this particular drug ... in Connecticut.”114 

Additionally, a number of the Medicare Part D beneficiaries receiving Subsys 

prescriptions from Ms. Alfonso could “testify that they did not have a cancer diagnosis, 
P A G E | 13

but that prior authorizations submitted on their behalf had represented that they had 

cancer.”115 

Plea hearing statements also explained that Insys paid Ms. Alfonso to speak at 

over 70 speakers programs—at the rate of around $1,000 per program.116 These 

programs were “basically a dinner at a nice restaurant where ... Ms. Alfonso was 

supposed to provide a presentation about the benefits of Subsys,” yet “in the majority 

of instances ... the only attendees at the speaker programs were individuals who had 

no license to prescribe controlled substances.”117 In addition, “at the majority of these 

dinner programs[,] Ms. Alfonso did not give any kind of presentation about Subsys ... 

[the programs were] basically a social engagement where everyone came to eat, 

drink, and it was paid for by ... Insys.”118 In exchange, Ms. Alfonso, with the 

encouragement of Insys sales representatives, “continued to increase her prescribing of 

Subsys and [try] to find more patients for whom she could prescribe the drugs.” 

In statements to prosecutors, “Ms. Alfonso admitted that the money she was paid 

influenced her prescribing of Subsys.”119 On June 23, 2015, Ms. Alfonso entered into a 

plea agreement in which she admitted to violating federal law by receiving kickbacks 

for prescribing Subsys.120

 

2. Initial Approaches to Ms. Alfonso

Over the course of 2012 and 2013, according to documents the minority staff 

reviewed, Insys employees repeatedly expressed interest in increasing Subsys 

prescribing from Ms. Alfonso. On August 1, 2012, for example, Insys President and CEO 

Michael Babich wrote to Insys sales representative Abe Rosenberg, stating that he had 

“listed your top targets below and need a brief weekly email summarizing how, if and 

when the doctor will write, if he is already and can he be a bigger doctor to you.”121 

The list of “top targets” included Heather Alfonso.122 In a response to Mr. Babich on 

August 1, 2012, Mr. Rosenberg wrote that Ms. Alfonso “is writing, likes [S]ubsys and says 

she wants to switch all patients off of Actiq to Subsys! I visit her at least once a week 

and sometimes twice.”123 Later, on August 17, 2012, Mr. Rosenberg stated in an email to 

Mr. Babich that he and Ms. Alfonso “had a nice discussion about getting more patients 

on Subsys,” and she had “expressed interest in becoming a speaker for us and I told her 

I would let her know as soon as we had another training scheduled.”124 

Yet in September 2012, Insys sales executive Xun (Sean) Yu provided sales 

personnel with a list of dispensed Subsys prescriptions with low strength and 

encouraged representatives to “work with your writers”—including Ms. Alfonso—“to 

titrate patients to their effective doses.”125 In response, Mr. Rosenberg stated that he 

spoke with “Heather Alfonso and she wants to titrate slowly. She is aware of the 

statistical analysis but she [sic] going to use her best judgment on [a] patient to patient 

basis.”126 Ms. Alfonso presumably met company expectations; by the beginning of 

October 2012, Mr. Rosenberg listed her as one of his top three “go to” physicians for 

Subsys prescriptions.127 By the middle of October, Insys had also approved Ms. Alfonso 

as an addition to the Insys speakers bureau.128 Frank Serra, Northeast Regional Sales 

Manager, noted in an October 12, 2017, email to an Insys marketing and sales 

communication specialist: “Abe is going to call you, Heather Alfonso is in.”129 In an 

email to Mr. Serra on October 17, 2012, Mr. Rosenberg stated that “Heather Alfonso has 
P A G E | 14

promised me she will switch all Actiq patients and I text her every morning to remind her 

as well as visit her 2 to 3 per week [sic]. They will come!!”130 Similarly, in an email to sales 

personnel on October 29, 2012, Mr. Serra noted that “Abe is on the phone constantly 

with Heather Alfonso.”131

Despite these developments, however, pressure from Insys management 

continued. On November 2, 2012, Mr. Serra met with Mr. Rosenberg and informed him 

that he was “failing to meet the standard for certain critical results of [his] position,” 

including his utilization of speakers programs.132 A subsequent “performance 

improvement plan” required Mr. Rosenberg to “have at least 4-5 programs executed 

for Heather Alfonso” prior to November 23, 2012.133 In an email dated November 9, 

2012, Mr. Burlakoff wrote to Mr. Serra with information on Heather Alfonso and asked 

“[w]hy has Abe not used this trained speaker to present via an [Insys Speaker 

Program].”134 Mr. Serra responded by stating that “[s]he definitely wants to speak, 

abe’s [sic] been in there working to get her dates and places lined up. [...] No excuses 

at all but he needs to finish this off.”135

3. Continued Pressure to Increase Prescribing from Ms. Alfonso

In a personal assessment in April 2013, Mr. Rosenberg listed one of his “strengths” 

as “[b]uilt a strong relationship with Heather Alfonso decile 9.”136 In a presentation the 

same month, he also noted that Ms. Alfonso “[w]orks in large pain practice [and] 

certainly has more patients that could benefit from treatment with subsys [sic].”137 Mr. 

Rosenberg added a “special note” in keeping with the Insys policy of leveraging 

personal relationships to boost prescriptions: “Her and I have become friends she def. 

will keep writing and I will use our friendship to increase script count and get more 

writing in CT.”138 Mr. Rosenberg also noted in a May 2013 email to Jeff Pearlman 

concerning Ms. Alfonso that “[t]o date she has influenced two prescribers to write. Dr. 

Feldman and Liza Paolini, Both [sic] have written multiple scrips [sic] and have 

committed to continue to write.”139 

Internal Insys rankings also confirmed the importance of Ms. Alfonso to the overall 

volume of Subsys prescriptions. On April 23, 2013, for example, Mr. Burlakoff sent a list of 

the top 25 Subsys prescribers—including Ms. Alfonso—for the previous 13 weeks to all 

sales personnel, noting that “[t]hese are our top performing customers, there are the 

clinicians that make us ‘tick.’”140 

Mr. Burlakoff further stated, however, that “I am still positive that the greatest 

opportunity for bonus dollars remain with the ‘big’ doctors whom are already sold on 

Subsys. In the majority of cases ‘not all’, you will notice that the top 25 Subsys 

prescribers still only give us a smidgeon of their ROO [rapid onset opioid] business. This 

of course means GREAT opportunity for growth!”141 Ms. Alfonso, for example, had 

generated $9,201 in net sales for Insys during the previous 13 weeks, yet Subsys 

prescriptions only constituted 21% of the 113 ROO prescriptions Ms. Alfonso had written 

during this time period.142

Similarly, on May 8, 2013, Mr. Burlakoff sent an email with a list of ROO 

prescribers—including Ms. Alfonso—and stated that “I look at some of these names, 
P A G E | 15

and I just can’t believe that we do not get at least 50 percent of their ROO business.”143 

Mr. Burlakoff speculated that “[e]ither one of two things is happening”: “You are NOT 

following the company’s direction and making it your 1 and only priority to OWN a 

customer” or “You are not having success, tell my why?”144 Mr. Burlakoff further stated 

that “[w]e give our blood, heart, and souls to these customers, and we can’t even get 

half the business that I know we have in fact EARNED?”145 Mr. Burlakoff closed by 

noting that the list of prescribers and prescribing history he had attached to his email 

represented “an enormous slap in the face that none of us deserve....”146

Perhaps in response to the email from Mr. Burlakoff, Jeff Pearlman wrote to Mr. 

Rosenberg on May 29, 2013, stating that he “wanted to bring to your attention the 

prescribing pattern of Heather Alfonso, someone you have recommended as a 

speaker to influence others and educate them in the use of Subsys.”147 Mr. Pearlman 

noted that “[i]t may be a struggle for her to identify new patients on a regular basis who 

will benefit from the use of Subsys.”148 Mr. Pearlman also noted that “[w]ith the 

exception of one recent script, every script is for 30 units. The average script trx runs in 

the 70-80 range and it is pretty standard for many of the patients to be using the drug 

up to 4 times per day, allowing for a 120 count script. She does not have a single 

patient on a 4x/day regimen. Why not?”149 Based on these indications, Mr. Pearlman 

concluded that Ms. Alfonso “has either not been sold on the true benefits of using our 

product as the real break through [sic] pain remedy or she has some insecurities still 

which keep her from prescribing it at the ‘usual’ 120 count. Given these facts is this 

really someone we can feel comfortable that they are representing our product well 

and are helping you to promote Subsys in the best light to other prescribers?”150

In response, Mr. Rosenberg stated that Ms. Alfonso “has informed me that in her 

opinion it [sic] ‘safe practice’ to first titrate slowly and then also to slowly increased the 

times per day. Both practices I personally support and also know Insys as the new 

branded leader in the ROO’s [sic] market does as well.”151 Mr. Rosenberg noted, 

however, that “Heather has assured me she will continue to increase script units on a 

[sic] ‘individual patient’ basis and need.”152 Mr. Pearlman responded by stating that 

although he was “not in a position to say what her patients should be getting as far as 

30 or 120,” Mr. Rosenberg had previously confirmed that Ms. Alfonso could find one 

new patient a week and “it is clear that is not happening.”153 Mr. Pearlman further 

stated that “[v]ery simply when I look at return on investment as she has not motivated 

any new prescribers as of yet and she is not significantly her own business, I am going to 

have tremendous difficult in justifying more programs.”154 Mr. Rosenberg replied that he 

“fully understand[s] your concern” and “will continue to remind [Alfonso] of that verbal 

agreement.”155

Internal Insys communications also suggest Mr. Pearlman himself intervened 

directly with Ms. Alfonso to boost prescriptions. In an email to Mr. Burlakoff in June 2013 

with the subject line, “watch out,” Mr. Pearlman stated that “[a]fter my trip yesterday 

and today I am telling you to watch out for Heather Alfonso (Abe’s). Of course I am 

thinking KOD [possibly “kiss of death”] as I type this, but wouldn’t be the sales person I 

am if I didn’t believe in what I think I just accomplished and what I expect to see.”156 

According to a qui tam complaint filed in June 2016—unsealed when the United States 

intervened in the litigation in April 2018—Mr. Babich has referred to low Subsys dosages 
P A G E | 16

as “the kiss of death.”157 The complaint further states that the “kiss of death” message 

“consists of telling doctors that 100 mcg is not effective for pain relief and continually 

pushing them to titrate to higher dosages.”158 Moreover, “[w]hile INSYS refrains from 

referencing the kiss of death...message in official emails and statements, INSYS 

management encourages this marketing scheme in person.”159 

 

Over the next several months, Insys executives continued to pressure Mr. 

Rosenberg to boost Subsys prescriptions from Ms. Alfonso. On August 30, 2013, for 

example, Sunrise Lee—a regional sales director—sent a list of “key clinicians to target” 

to Mr. Burlakoff. The list included a section on “primary targets,” which again included 

Heather Alfonso.160 Over a month later, on October 9, 2013, Mr. Burlakoff sent an email 

to district and regional sales managers “highlighting some key ‘ROO’ prescribers whom 

have failed us tremendously. [...] Focus on the big ROO writers whom are giving us less 

than 50 percent, demand the business you have worked so hard to EARN.”161 This list 

included Ms. Alfonso.162 Mr. Burlakoff also urged sales executives to ask themselves a 

series of questions: 

Did we do enough to earn more than 50 percent of their ROO business? If 

so, did we have a ‘heart to heart’ with our customer to address our valid 

concerns pertaining to the lack of business we are currently getting? If we 

had the ‘heart to heart’ and we are still not getting more than 50 percent, 

why the hec [sic] are we still spending the majority of our time and 

resources there!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!163

Mr. Burlakoff added that there was “[w]ay too much business left on the table, 

please address each rep individually and light a fire under them. We are sales 

people.... Sales people have pride............ Our pride has to be hurting big time as a 

direct result of some of these doctors [sic] prescribing habits....”164

4. Examples of Alfonso Prescriptions 

In an email dated February 4, 2014, Jonathan Roper, an Insys district sales 

manager, noted to regional sales director Sunrise Lee that Heather Alfonso’s “business 

has increased greatly since being given more spaeker [sic] programs and she has also 

helped in many new writer activations.”165 In fact, based on a review of prior 

authorization forms and other paperwork, Ms. Alfonso appears to have written 

numerous prescriptions to treat ailments apart from breakthrough cancer pain—the 

only FDA-approved indication for Subsys.166 For example, Ms. Alfonso completed 

paperwork to obtain Subsys for patients suffering from chronic pain,167 chronic pain 

syndrome, dysphagia,168 abdominal pain,169 neck and upper extremity pain,170 “[r]ight 

sided low back pain,”171 chronic axial low back pain and leg pain,172 neck and bilateral 

shoulder pain,173 and chronic occipital neuralgia,174 among other non-cancer-related 

ailments. 
P A G E | 17

5. End of Relationship with Alfonso

Insys ended its relationship with Ms. Alfonso just months before the Department of 

Justice announced her guilty plea in June 2015.175 On April 14, 2015, an employee of a 

third-party contractor sent a list of all speakers programs events with Ms. Alfonso and 

stated: “Please let me know if we should cancel the programs or if another speaker will 

replace her for some of the ones taking place in the next few weeks.”176 In an email 

dated April 28, 2015, the employee noted that five programs had been scheduled for 

Ms. Alfonso, but “[b]y an update I received today from Insys Ms. Alfonso is no longer 

active. [...] We are holding all planning of these until receiving further direction.”177 

(Mr. Rosenberg left Insys in the fall of 2013.178)

B. Dr. Steven Simon 

In July 2017, FBI agents seized patient records from Dr. Steven Simon, a pain 

specialist operating outside Kansas City, Missouri, in Overland Park, Kansas.179 

According to the Kansas City Star, Dr. Simon “was the eighth-highest-paid Subsys 

speaker nationally from August 2013 to December 2015, taking in more than $200,000 in 

meals, speaking fees and related travel expenses.”180 According to the CMS Open 

Payments database, Dr. Simon accepted over $230,000 from Insys between 2013 and 

2016.181 As mentioned above, Dr. Simon also ranked as the top prescriber of Subsys in 

the Medicare Part D program in Kansas, as well as “the top-paid Kansas doctor in the 

Subsys speaking program.”182 

According to recent lawsuits, Dr. Simon aggressively pushed Subsys in high 

volumes and dosages even in cases in which patients lacked a cancer diagnosis and 

complained of side effects. One former patient has alleged, for example, that Dr. 

Simon prescribed Subsys even after the patient—who did not have a cancer 

diagnosis—was discharged from the hospital with the recommendation that he “begin 

to taper opioids” because “continuing at current high amounts is likely not realistic as 

an outpatient.”183 After a year on Subsys, this patient has stated, a nurse in Dr. Simon’s 

office asked him if he would “feel comfortable telling me that you have at least 

precancerous cells”—presumably to aid in the prior authorization process for the 

medication.184 Later, an Insys sales representative visiting the clinic advised on 

insurance approval issues and even urged the patient to change insurers.185 Between 

December 2013 and May 2014, according to medical records, Dr. Simon and his nurse 

increased the Subsys dosage for this patient to the “maximum allowable and most 

expensive dose.”186 

Similarly, in a lawsuit filed in January 2018, the husband of a now-deceased 

patient alleged that Dr. Simon quickly increased the Subsys dosages his wife received 

for back pain between 2013 and 2014—despite a lack of a cancer diagnosis.187 Dr. 

Simon also allegedly created “fully executed pre-signed prescriptions for patients to 

refill Subsys” to accommodate patients as he traveled for speaking engagements with 

pharamceutical companies.188 The patient at issue eventually died of “fentanyl 

intoxication with contribution from underlying diseases.”189 According to the January 

2018 complaint, Dr. Simon never informed the patient or her husband that Subsys 

carried a risk of overdose.190 
P A G E | 18

Another patient—who did, in fact, have “an ongoing diagnosis of leukemia”—

complained of side effects from Subsys, but “Dr. Simon continued to push Subsys on her 

the entire time she was under his care” between 2013 and 2015.191 Dr. Simon also 

allegedly left signed prescriptions for this patient when he traveled for speaking 

engagements.192 In fact, the patient recalls Dr. Simon boasting of the frequent trips 

pharmaceutical companies provided: “He said he was going to Miami, and they were 

going to give him a convertible, and he was going to stay in the best hotel and eat the 

best Cuban food he'd ever had.”193

Insys documents the minority staff reviewed demonstrate the importance the 

company attached to Dr. Simon and his prescribing habits. According to an internal 

Insys spreadsheet, for example, Subsys accounted for a high percentage of Dr. Simon’s 

rapid onset opioid prescribing. In April 2013, as mentioned above, Mr. Burlakoff sent a 

list of the top 25 Subsys prescribers for the previous 13 weeks to all sales personnel, 

noting that “[t]hese are our top performing customers, there are the clinicians that 

make us ‘tick.’”194 Mr. Burlakoff also stressed that “the greatest opportunity for bonus 

dollars remain with the ‘big’ doctors whom are already sold on Subsys” and explained 

that boosting the ROO prescribing share for the top 25 Subsys prescribers “means 

GREAT opportunity for growth!”195 

This list included Dr. Simon, who appeared in the top 15 prescribers.196 According 

to the spreadsheet, Dr. Simon generated $107,656 in net sales for Subsys during the 

previous 13 weeks. But unlike certain other doctors on the list, Dr. Simon was a loyal 

prescriber; Subsys prescriptions constituted 84% of the 113 ROO prescriptions Dr. Simon

had written in the previous 13 weeks.197 The chart also noted that Dr. Simon had 

prescribed $138,254 in ROO prescriptions over the previous three months.198

As mentioned previously, Mr. Burlakoff also sent an email in May 2013 that 

contained a list of ROO prescribers—including Dr. Simon—and stated that “I look at 

some of these names, and I just can’t believe that we do not get at least 50 percent of 

their ROO business.”199 Mr. Burlakoff speculated that sales representatives had not 

“owned” their physicians, complained that Insys had not received the prescriptions it 

had “earned,” and described the prescribing histories he attached as “an enormous 

slap in the face.”200

In a reply to this email, Insys sales executive Richard Simon sent an email to his 

team asking them to “[p]lease look at this list. Look at the TWO top potential people on 

this list that are underperforming within your geography and please respond what your 

plan is to turn this around.”201 Mr. Simon further stated that “with every highlighted 

physician [on the list] there is an opportunity to make an impact.”202 Dr. Simon was not 

highlighted on the attached list, however; according to the spreadsheet, Subsys 

accounted for 82% of Dr. Simon’s ROO prescribing during the relevant period, which 

placed him above the 50% threshold Mr. Burlakoff had mentioned.203

Dr. Simon also appears on several lists for proposed Insys panels related to pain 

management practices. He appears, for example, on a list of physicians for a “Pain 

Practice Steering Committee” and a “Pain Oral Solution Practice Steering 
P A G E | 19

Committee.”204 The list of physicians for this second committee designates Dr. Simon as 

a “decile 10” prescriber—the highest ranking Insys used for Subsys-prescribing 

physicians.205 He also appears on a list of physicians scheduled to attend an “in-person 

consultant meeting” at the JW Marriott Scottsdale Camelback resort in Scottsdale, 

Arizona, in March 2012206 and on a November 2012 list of invitees for a “2013 Strategic 

Planning Ad Board” event planned for January 2013.207 

In later Insys documents, Torgny Andersson appears as the designated sales 

representative for Dr. Simon.208 In October 2013, Mr. Andersson filed a qui tam

complaint against Insys, claiming that the company made false claims for 

reimbursement to federal health insurance programs.209 Among other allegations, the 

complaint asserts the Insys sales force “has offered and made unlawful financial 

inducements to providers to encourage them to prescribe Insys drugs.”210 While 

counsel for Dr. Simon has claimed “this suit does not relate to or affect Dr. Simon,” Dr. 

Simon has stated that Mr. Anderson served as his primary point of contact at Insys.211

Dr. Simon was not the only Insys-targeted physician in the Missouri and Kansas 

areas to later come under scrutiny for their prescribing practices. In an email to Mr. 

Babich listing Insys sales representatives and their assigned physicians, Dr. Simon 

appears below an Insys representative operating out of Kansas City, Kansas.212 Dr. 

Randall Halley and Dr. Anthony Guarino—both of Missouri—appear on this list as well.213 

Dr. Guarino, a St. Louis area anesthesiologist, was one of the leading recipients of 

pharmaceutical company payments in 2009 and 2010—receiving over $250,000 over 18 

months—while prescribing drugs from the same companies.214 And in 2015, the owner 

of a Springfield-area pharmacy chain—Missouri Rep. Lynn Morris—acknowledged filling 

false prescriptions under Dr. Halley’s name.215 Dr. Guarino and Dr. Halley received 

$106,434.84 and $87,859.41, respectively, from Insys between 2013 and 2016.216 See 

Appendix A for additional information.

CONCLUSION

On October 24, 2017, federal prosecutors issued an indictment against senior 

Insys executives, including founder and former CEO Dr. John Kapoor, former CEO 

Michael Babich, Alec Burlakoff, and Richard Simon.217 According to the indictment, 

these executives “sought to devise and foster a scheme to profit by using bribes and 

fraud to cause the illicit distribution” of Subsys.218 In correspondence with the 

Committee on September 1, 2017, new Insys CEO Saeed Motahari stated that “the 

company has taken necessary steps to ensure that we will not repeat the mistakes of 

the past.”219

Even as Insys takes action to reform the sales and marketing techniques Dr. 

Kapoor, Mr. Babich, and Mr. Burlakoff instituted, the industry-wide threat of speakers 

programs affecting the volume and strength of prescriptions continues. Just as Insys 

adopted and expanded methods Purdue pioneered, the next pharmaceutical 

company moving rapidly to establish market share in a crowded field may look to Insys 

as a model. And so long as both sales representatives and prescribers have strong 

financial incentives to boost prescriptions, simple greed will continue to distort the 
P A G E | 20

patient-physician relationship. As a result, this report represents a warning to 

policymakers seeking to prevent actors in the pharmaceutical industry from fueling the 

next public health crisis. 
P A G E | 21

APPENDIX A
P A G E | 22

Figure 1: Count of Prescribers by Opioid Claim Count in Part D in 2015220

Figure 2: Count of Prescribers by Opioid Claim Count in Part D in 2016221

426,170

41,344

15,074 6,801 3,625 2,231 1,344 963 688 507 2,148

1 to 251 251 to

500

501 to

749

751 to

998

1001 to

1247

1251 to

1496

1501 to

1745

1751 to

1994

2001 to

2243

2251 to

2492

2501+

Anthony Guarino: 3,915

Randall Halley: 3,885

Steven Simon: 2,527

Heather Alfonso: 1162

427,365

40,217

14,544 6,580 3,645 2,131 1,406 976 732 559 2,280

1 to 250 251 to

500

501 to

750

751 to

1000

1001 to

1250

1251 to

1500

1501 to

1750

1751 to

2000

2001 to

2250

2251 to

2500

2501+

Anthony Guarino: 3,759

Randall Halley: 3,644

Steven Simon: 1,386
P A G E | 23

Figure 3: Count of Prescribers by Opioid Costs in Part D in 2015222

Figure 4: Count of Prescribers by Opioid Costs in Part D in 2016223

494,118

3,939 1,277 594 325 182 119 64 55 39 127

1 to

100k

100k to

200k

200k to

300k

300k to

400k

400k to

500k

500k to

600k

600k to

700k

700k to

800k

800k to

900k

900k to

1M

1M+

Randall Halley:

$2,237,244.01

Heather Alfonso:

$575,016.90

Anthony Guarino:

$1,096,666.41

Steven Simon:

$1,038,349.67

493,811

3,885 1,279 558 332 177 142 61 41 32 117

1 to

100k

100k to

200k

200k to

300k

300k to

400k

400k to

500k

500k to

600k

600k to

700k

700k to

800k

800k to

900k

900k to

1M

1M+

Steven Simon:

$524,522.35 Anthony 

Guarino:

$780,716.39

Randall Halley:

$2,090,619.62
P A G E | 24

Figure 5: Count of Prescribers by Fentanyl Claim Count in Part D in 2015224

Figure 6: Count of Prescribers by Fentanyl Claim Count in Part D in 2016225

58,338

3,786

916 353 140 87 40 24 10 6 0

1 to 100 101 to

200

201 to

300

301 to

400

401 to

500

501 to

600

601 to

700

701 to

800

801 to

900

901 to

1000

1001+

Randall Halley: 716

Anthony Guarino: 479

Steven Simon: 325

Heather Alfonso: 99

55,707

3,617

875 311 136 83 34 28 11 8 22

1 to 100 101 to

200

201 to

300

301 to

400

401 to

500

501 to

600

601 to

700

701 to

800

801 to

900

901 to

1000

1001+

Steven Simon: 134

Anthony Guarino: 

383

Randall Halley: 

790
P A G E | 25

Figure 7: Count of Prescribers by Fentanyl Costs in Part D in 2015226

Figure 8: Count of Prescribers by Fentanyl Costs in Part D in 2016227

63,300

177 85 42 34 15 11 5 11 9 38

1 to

100k

100k to

200k

200k to

300k

300k to

400k

400k to

500k

500k to

600k

600k to

700k

700k to

800k

800k to

900k

900k to

1M

1M+

Steven Simon:

$477,338.52

Heather Alfonso:

$187,930.89

Anthony 

Guarino:

Randall Halley:

$828,150.18

60,484

123 72 47 29 18 13 11 3 5 27

1 to

100k

100k to

200k

200k to

300k

300k to

400k

400k to

500k

500k to

600k

600k to

700k

700k to

800k

800k to

900k

900k to

1M

1M+

Anthony

Guarino:

$57,275.66

Steven Simon:

$144,888.61

Randall Halley:

$1,027,850.77
P A G E | 26

1 Letter from Insys CEO Saeed Motahari to Sen. Claire McCaskill (Sept. 1, 2017). See Minority Staff, Senate Committee on 

Homeland Security and Governmental Affairs, Fueling an Epidemic: Insys Therapeutics and the Systemic Manipulation of 

Prior Authorization (Sept. 6, 2017) (Exhibit C) (www.hsgac.senate.gov/media/minority-media/breaking-mccaskill-opioidinvestigation-releases-first-report-detailing-systemic-manipulation-of-prior-authorization-process-by-insys-therapeutics-). 

2 Id. 

3 Id. 

4 Insys to Pay $150 Million to Settle Justice Department Investigation, Wall Street Journal (Aug. 8, 2018) 

(www.wsj.com/articles/insys-to-pay-150-million-to-settle-justice-department-investigation-1533733598).

5 Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury 

Prevention and Control, Opioid Overdose, Understanding the Epidemic 

(www.cdc.gov/drugoverdose/epidemic/index.html) (accessed June 13, 2018). See also Rose A. Rudd, et al., Increases 

in Drug and Opioid Overdose Deaths — United States, 2000–2014, Morbidity and Mortality Weekly Report (Jan. 1, 2016); 

Leonard J. Paulozzi, et al., Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999—2008, 

Morbidity and Mortality Weekly Report (Nov. 4, 2011); Department of Health and Human Services, Centers for Disease 

Control and Prevention, National Center for Injury Prevention and Control, Vital Signs, Opioid Overdoses Treated in 

Emergency Departments (www.cdc.gov/vitalsigns/opioid-overdoses/) (accessed June 13, 2018); Rose A. Rudd, et al., 

Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015, Morbidity and Mortality Weekly 

Report (Dec. 16, 2016); Department of Health and Human Services, National Institutes of Health, National Institute on 

Alcohol Abuse and Alcoholism: Rates of Nonmedical Prescription Opioid Use and Opioid Use Disorder Double in 10 Years

(June 22, 2016) (www.niaaa.nih.gov/news-events/news-releases/rates-nonmedical-prescription-opioid-use-and-opioiduse-disorder-double-10). 

6 Production from Depomed, Inc. to the Senate Committee on Homeland Security and Governmental Affairs (May 17, 

2017) (DEP00000205).

7 The Food and Drug Administration (FDA) approved OxyContin in December 1995. See Department of Health and 

Human Services, Food and Drug Administration, Timeline of Selected FDA Activities and Significant Events Addressing 

Opioid Misuse and Abuse (Apr. 23, 2018) 

(www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM566985.pdf).

8 The Family that Built an Empire of Pain, The New Yorker (Oct. 30, 2017) 

(www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain).

9 The Secretive Family Making Billions From the Opioid Crisis, Esquire (Oct. 16, 2017) (www.esquire.com/newspolitics/a12775932/sackler-family-oxycontin/); The Family that Built an Empire of Pain, The New Yorker (Oct. 30, 2017) 

(www.newyorker.com/magazine/2017/ 10/30/the-family-that-built-an-empire-of-pain). 

10 The Family that Built an Empire of Pain, The New Yorker (Oct. 30, 2017) 

(www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain); Complaint (Jan. 8, 2018), Jennings 

County v. Purdue Pharma L.P., et al., S.D. Ind. (No. 4:18 CV 6).

11 Plaintiff’s Complaint for Violation of the Michigan Consumer Protection Act, Public Nuisance, Negligence, Unjust 

Enrichment, and Violation of the Racketeer Influenced and Corrupt Organization Act (Jan. 22, 2018), County of Monroe 

v. Purdue Pharma L.P., et al., E.D. Mich. (No. 2:18 CV 10251).

12 ‘You Want a Description of Hell?’ OxyContin’s 12-Hour Problem, Los Angeles Times (May 5, 2016) 

(www.latimes.com/projects/oxycontin-part1/).

13 Id.

14 Id.

15 Plaintiff’s Complaint for Public Nuisance, Negligence Per Se, Negligence, and Violations of the Racketeer Influenced 

and Corrupt Organization Act (Mar. 13, 2018), City of Iron Mountain, Michigan v. Purdue Pharma L.P., et al., W.D. Mich. 

(No. 2:18 CV 00037).

16 Dr. Art Van Zee, The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy, American 

Journal of Public Health (Feb. 2009) (www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/). 

17 The More Opioids Doctors Prescribe, the More Money They Make, CNN (Mar. 12, 2018) 

(www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html).

18 OxyContin Maker Purdue Pharma Stops Promoting Opioids, Cuts Sales Staff, Washington Post (Feb. 10, 2018) 

(www.washingtonpost.com/national/health-science/oxycontin-maker-purdue-pharma-to-stop-promoting-the-drug-todoctors/2018/02/10/c59be118-0ea7-11e8-95a5-c396801049ef_story.html).

 
P A G E | 27

 

19 New York State Health Foundation, Follow the Money: Pharmaceutical Manufacturer Payments and Opioid Prescribing 

Patterns in New York State (June 2018) (nyshealthfoundation.org/wp-content/uploads/2018/06/following-the-moneypharmaceutical-payments-opioid-prescribing-june-2018.pdf).

20 Scott E. Hadland, et al., Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians with 

Subsequent Opioid Prescribing, JAMA Internal Medicine (May 14, 2018) 

(jamanetwork.com/journals/jamainternalmedicine/fullarticle/2681059). Notably, Insys “accounted for 50% of the 

nonresearch payments.” Id. 

21 The More Opioids Doctors Prescribe, the More Money They Make, CNN (Mar. 12, 2018) 

(www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html).

22 Id.

23 Visha Bala, et al., Possible Side Effects, CareDash Analytics (2018) (www.caredash.com/press-release/payments-fullreport-final-2.pdf).

24 Complaint for Violation of the New Jersey False Claims Act (Oct. 5, 2017), Porrino v. Insys Therapeutics, Inc., Sup. Ct. of 

N.J. Chancery Div. (No. A 8:54) (nj.gov/oag/ newsreleases17/Insys-Complaint.pdf).

25 The Pain Hustlers, New York Times (May 2, 2018) (www.nytimes.com/interactive/2018/05/02/magazine/money-issueinsys-opioids-kickbacks.html); Securities and Exchange Commission, Form 10-K Submitted by Insys Therapeutics, Inc.

(Commission File Number: 1- 35902) (Mar. 4, 2014) 

(www.sec.gov/Archives/edgar/data/1516479/000143774914003376/insy20131231_10k.htm). 

26 More Evidence Companies Pay Some Doctors to Prescribe Opioids, NBC News (May 14, 2018) 

(www.nbcnews.com/health/health-news/more-evidence-companies-pay-some-doctors-prescribe-opioidsn873961?cid=sm_npd_nn_tw_ma); The Pain Hustlers, New York Times (May 2, 2018) 

(www.nytimes.com/interactive/2018/05/02/magazine/money-issue-insys-opioids-kickbacks.html). According to a recent 

analysis, physician payments related to Subsys declined from around $6 million in 2015 to under $2.4 million in 2016. 

Opioid-Makers Cut Back on Marketing Payments to Doctors, NPR (June 28, 2018) (www.npr.org/sections/healthshots/2018/06/28/621968053/opioid-makers-cut-back-on-marketing-payments-to-doctors).

27 Senate Committee on Homeland Security and Governmental Affairs Minority Staff, Roundtable Transcript, Minority Staff 

Roundtable: Fueling an Epidemic: Insys Therapeutics and the Systemic Manipulation of Prior Authorization, 115th Cong. 

(Sept. 12, 2017).

28 Open Payments Data, Centers for Medicare and Medicaid Services, Physician Profile for William Tham (accessed Aug. 

3, 2017) (openpaymentsdata.cms.gov/ physician/277689/summary).

29 The Pain Hustlers, New York Times (May 2, 2018) (www.nytimes.com/interactive/2018/05/02/magazine/money-issueinsys-opioids-kickbacks.html).

30 Id.

31 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00986277).

32 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: 2015 Part D Prescriber

(Oct. 31, 2017) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-201/3z4d-vmhm); 

Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: 2014 Part D Prescriber (Oct. 

31, 2017) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-201/465c-49pb); Centers for 

Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: 2013 Part D Prescriber (Oct. 31, 2017) 

(data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-201/4uvc-gbfz); Centers for Medicare 

& Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber Summary Table CY2015 (Oct. 31, 

2017) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-Par/qywy-pajd).

33 Id.

34 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs

(Aug. 27, 2017) (INS-BOS-00259439).

35 Id.

36 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00259440).

37 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01081021).

38 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01027431).
P A G E | 28

 

39 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01027440).

40 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01027444).

41 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01009498).

42 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01009500).

43 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00589621).

44 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 12, 2017) (INSYS_HSGAC_00006045).

45 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00589623).

46 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 24, 2017) (INSYS_HSGAC_00007188-R).

47 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 24, 2017) (INSYS_HSGAC_00007191-R).

48 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

May 24, 2017) (INSYS_HSGAC_00007192-R).

49 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 24, 2017) (INSYS_HSGAC_00007229-R).

50 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 24, 2017) (INSYS_HSGAC_00006036-R).

51 Id.

52 Id. (emphasis in original).

53 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00276257).

54 Id.

55 Complaint for Violation of 18 U.S.C. §§ 371 and 2 and 42 U.S.C. § 1320a-7b(b)(2)(B) (June 8, 2016), United States of 

America v. Roper, S.D.N.Y. (No. 16 MAG 3628).

56 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01222132).

57 Plaintiffs’ First Amended Complaint for Violation of the New Jersey False Claims Act, as well as other Claims (Nov. 16, 

2017), Porrino v. Insys Therapeutics, Inc., and John Kapoor, N.J. Super. Ct. (No. MID-C-162-17).

58 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 12, 2017) (INSYS_HSGAC_00007775).

59 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 12, 2017) (INSYS_HSGAC_00007778).

60 Id.

61 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 12, 2017) (INSYS_HSGAC_00007781).

62 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 12, 2017) (INSYS_HSGAC_00007780).

63 Id.

64 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 12, 2017) (INSYS_HSGAC_00007794).

65 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(May 12, 2017) (INSYS_HSGAC_00007784).
P A G E | 29

 

66 Plaintiffs’ First Amended Complaint for Violation of the New Jersey False Claims Act, as well as other Claims (Nov. 16, 

2017), Porrino v. Insys Therapeutics, Inc., and John Kapoor, N.J. Super. Ct. (No. MID-C-162-17).

67 Id.

68 Id.

69 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00235599).

70 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00241138).

71 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00406275).

72 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01179501).

73 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01179503).

74 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01291403).

75 Id.

76 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01058063).

77 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01021271).

78 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01028895).

79 Id.

80 Id.

81 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01377055-59).

82 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01377055).

83 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00235400).

84 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01077246).

85 Id.

86 Id.

87 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01077247).

88 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01377057).

89 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01377056).

90 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01377058).

91 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00241138).

92 The Pain Killer: A Drug Company Putting Profits Above Patients, CNBC (Nov. 4, 2015) (www.cnbc.com/2015/11/04/thedeadly-drug-appeal-of-insys-pharmaceuticals.html).

93 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00486492).
P A G E | 30

 

94 Id.

95 Id.

96 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00486492-93).

97 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00486493).

98 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00407939-40).

99 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00396918).

100 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00396919).

101 Complaint for Violation of 18 U.S.C. §§ 371 and 2 and 42 U.S.C. § 1320a-7b (b) (2) (B) (June 8, 2016), United States of 

America v. Roper, S.D.N.Y. (No. 16 MAG 3628).

102 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01371418).

103 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01031468).

104 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00495776).

105 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01014623).

106 Complaint for Violation of 18 U.S.C. §§ 371 and 2 and 42 U.S.C. § 1320a-7b (b) (2) (B) (June 8, 2016), United States of 

America v. Roper, S.D.N.Y. (No. 16 MAG 3628) (emphasis added).

107 Information (June 23, 2015), U.S. v. Heather Alfonso, D. Conn. (No. 3:15-cr-00111); see also Plea Hearing (June 23, 

2015), U.S. v. Heather Alfonso, D. Conn. (No. 3:15-cr-00111); and 42 U.S.C. § 1320a-7b(b)(1).

108 Information (June 23, 2015), U.S. v. Heather Alfonso, D. Conn. (No. 3:15-cr-00111); see also 42 U.S.C. § 1320a-7b(b)(1).

109 Second Patient Says Doctor Under FBI Investigation Pushed Opioid Spray, Kansas City Star (Sept. 5, 2017) 

(www.kansascity.com/news/business/health-care/article171412822.html).

110 Centers for Medicare and Medicaid Services, Steven M. Simon, Open Payments Data, 

(openpaymentsdata.cms.gov/physician/386520/summary) (accessed May 29, 2018). 

111 Second Patient Says Doctor Under FBI Investigation Pushed Opioid Spray, Kansas City Star (Sept. 5, 2017) 

(www.kansascity.com/news/business/health-care/article171412822.html).

112 FBI Seizes Records of Overland Park Pain Doctor Tied to Insys, Kansas City Star (July 19, 2017) 

(www.kansascity.com/news/business/health-care/article162569383.html).

113 Plea Hearing (June 23, 2015), U.S. v. Heather Alfonso, D. Conn. (No. 3:15-cr-00111).

114 Id.

115 Id.

116 Id.

117 Id.

118 Id.

119 Id.

120 Plea Agreement Letter (June 23, 2015), U.S. v. Heather Alfonso, D. Conn. (No. 3:15-cr-00111); see also 42 U.S.C. § 

1320a-7b(b)(1).

121 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01017784).

122 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01017785).
P A G E | 31

 

123 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01060255).

124 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01370925).

125 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01295161).

126 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01295160).

127 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01371417).

128 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01022111).

129 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01372194).

130 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01372372).

131 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01009356).

132 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01028253-54).

133 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01028254).

134 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01019987).

135 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01028310).

136 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01404181).

137 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01083656).

138 Id.

139 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01417446).

140 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01004973).

141 Id.

142 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01004979).

143 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01005027).

144 Id.

145 Id.

146 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01005028).

147 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01121885).

148 Id.

149 Id.

150 Id.
P A G E | 32

 

151 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01127761).

152 Id.

153 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01127763).

154 Id.

155 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01127767).

156 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00988849). On August 8, 2018, the Department of Justice announced that Mr. Pearlman 

pleaded guilty to inducing “certain physicians, advanced practice registered nurses...and physicians’ assistants to 

prescribe Subsys by paying them to participate in numerous sham ‘Speaker Programs.’” Department of Justice: Drug 

Company Manager Admits Role in Kickback Scheme Related to Fentanyl Spray Prescriptions (Aug. 8, 2018) 

(www.justice.gov/usao-ct/pr/drug-company-manager-admits-role-kickback-scheme-related-fentanyl-sprayprescriptions). Mr. Pearlman “arranged $83,000 in kickbacks to Heather Alfonso” and “collected a $95,000 quarterly 

bonus in 2013 based on his success selling Subsys.” Former Drug Company Official Pleads Guilty in Fraud and Kickback 

Scheme That Cost Medicare Millions, Hartford Courant (Aug. 8, 2018) (www.courant.com/ news/connecticut/hc-subsyspearlman-plea-0809-story.html). 

157 Second Amended Complaint for Violations of the Federal False Claims Act and State False Claims Acts (June 13, 

2016), United States of America ex rel. Guzman v. Insys Therapeutic, Inc., [sic] et al., C.D. Cal. (No. CV 13 5861).

158 Id.

159 Id.

160 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00987172).

161 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00987019).

162 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00987021).

163 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00987019).

164 Id.

165 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01368106).

166 Insys Therapeutics, Inc., Approved Products (www.insysrx.com/products/approved) (accessed May 29, 2018).

167 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00784553).

168 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00784576).

169 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00784591).

170 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00794954).

171 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00794971).

172 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00842265).

173 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00842499).

174 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00842933).
P A G E | 33

 

175 Department of Justice: APRN Admits Receiving Kickbacks from Drug Company for Prescribing Medication (June 23, 

2015) (www.justice.gov/usao-ct/pr/aprn-admits-receiving-kickbacks-drug-company-prescribing-pain-medication).

176 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01433609).

177 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01433435).

178 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00987139-40).

179 FBI Seizes Records of Overland Park Pain Doctor Tied to Insys, Kansas City Star (July 19, 2017) 

(www.kansascity.com/news/business/health-care/article162569383.html).

180 Id.

181 Centers for Medicare and Medicaid Services, Steven M. Simon, Open Payments Data, 

(openpaymentsdata.cms.gov/physician/386520/summary) (accessed May 29, 2018).

182 FBI Seizes Records of Overland Park Pain Doctor Tied to Insys, Kansas City Star (July 19, 2017) 

(www.kansascity.com/news/business/health-care/article162569383.html).

183 Former Patient: Overland Park Pain Doctor Pushed Opioid, Nurse Asked Him to Lie, Kansas City Star (July 20, 2017) 

(www.kansascity.com/news/business/health-care/article162582358.html).

184 Id.

185 Id.

186 Id.

187 Kansas Doctor Sued in Woman’s Fentanyl Overdose Death, Associated Press (Feb. 20, 2018) 

(www.apnews.com/68ad111e4712457988063cf08f1aac01).

188 Fatal Fentanyl Overdose Caused by Kansas Doctor, Suit Says. This is His Third Suit, Kansas City Star (Feb. 20, 2018) 

(www.kansascity.com/news/business/health-care/article201048979.html).

189 Id.

190 Id. According to a lawsuit filed in July 2018 by another former patient, Dr. Simon “aggressively pushed for the 

continued use and increasing doses of Subsys consistent with the Subsys marketing program instead of exploring other, 

non-narcotic pain options.” Another Lawsuit Accuses Overland Park Doctor of Kickbacks from Opioid Spray Maker, 

Kansas City Star (July 13, 2018) (www.kansascity.com/news/local/ article214834685.html). In addition, Dr. Simon 

allegedly failed to inform the patient of the risk of overdose and addiction from oral fentanyl and “falsely represented to 

the Plaintiff that the fact she previously had cancer qualified her to use Subsys.” Id.

191 Second Patient Says Doctor under FBI Investigation Pushed Opioid Spray, Kansas City Star (Sept. 5, 2017) 

(www.kansascity.com/news/business/health-care/article171412822.html).

192 Id.

193 The More Opioids Doctors Prescribe, the More Money They Make, CNN (Mar. 12, 2018) 

(www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html).

194 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01004973).

195 Id.

196 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00995591).

197 Id.

198 Id.

199 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01005027).

200 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01005028).

201 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00989340).
P A G E | 34

 

202 Id.

203 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00989344).

204 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00989674-75).

205 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00989675).

206 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00990862; INS-BOS-00990868).

207 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01187260).

208 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-01187267).

209 Original Complaint for Violations of the Federal False Claims Act (Oct. 15, 2013), United States ex rel. Torgny Andersson 

v. Insys Therapeutics, Inc., D. Mass. (No. 14 CV 9179) (www.documentcloud.org/documents/4489342-Andersson-vInsys.html).

210 Id.

211 Drug Rep for Doctor Sued Over Fentanyl Spray Prescriptions Revealed as Whistleblower, Kansas City Star (May 31, 

2018) (www.kansascity.com/news/business/health-care/article212260139.html).

212 Production from Insys Therapeutics, Inc., to the Senate Committee on Homeland Security and Governmental Affairs 

(Aug. 27, 2017) (INS-BOS-00990857).

213 Id.

214 Database Has Drug Firms’ Payments to 17,000 Doctors, St. Louis Post-Dispatch (Nov. 29, 2010) 

(www.stltoday.com/news/local/metro/database-has-drug-firms-payments-to-doctors/article_0cd2662c-970e-5311-ad0f61418464cb33.html).

215 Rep. Lynn Morris Disciplined for Filling False Prescriptions, Springfield News-Leader (May 29, 2015) (www.newsleader.com/story/news/politics/2015/05/29/rep-lynn-morris-disciplined-filling-false-prescriptions/28148567/).

216 Centers for Medicare and Medicaid Services, Anthony H. Guarino, Open Payments Data 

(openpaymentsdata.cms.gov/physician/163707/payment-information) (accessed May 29, 2018); Centers for Medicare 

and Medicaid Services, Randall E. Halley, Open Payments Data 

(openpaymentsdata.cms.gov/physician/237491/payment-information) (accessed May 29, 2018).

217 First Superseding Indictment (Oct. 24, 2017), U.S. v. Babich et al., D. Mass. (No. 1:16-cr-10343).

218 Id.

219 Letter from Insys CEO Saeed Motahari to Sen. Claire McCaskill (Sept. 1, 2017). 

220 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber 

Summary Table CY2015 (Oct. 31, 2017) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-PaymentData-Par/qywy-pajd). 

221 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber 

Summary Table CY2016 (Apr. 19, 2018) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-PaymentData-Par/c9xz-7zpd).

222 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber 

Summary Table CY2015 (Oct. 31, 2017) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-PaymentData-Par/qywy-pajd).

223 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber 

Summary Table CY2016 (Apr. 19, 2018) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-PaymentData-Par/c9xz-7zpd).

224 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber CY2015

(May 25, 2017) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-201/3z4d-vmhm).

225 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber CY2016

(May 15, 2018) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-201/yvpj-pmj2).
P A G E | 35

 

226 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber CY2015

(May 25, 2017) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-201/3z4d-vmhm).

227 Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data: Part D Prescriber CY2016

(May 15, 2018) (data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-201/yvpj-pmj2).
EXHIBITS
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The Opioid Epidemic1: The~ ~O for Guidelines ~ 

• Prescription opioid sales in the United States have increased by 300°/o 

since 1999 without a commensurate increase in the amount of pain 

• Approximately 1.9 million Americans, age 12 or older, either abused or 

were dependent on opioid pain relievers in 20142 

• More than 14,000 deaths occurred in 2014, four times the number of 

overdose deaths related to prescription opioids in 19993 

• The total societal costs of prescription opioid abuse in the U.S. have 

been estimated at $55.7 billion4 

3 1 

1Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1-49. DOI: 

http://dx.doi.org/10.15585/mmwr.rr6501 e1. 2Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS 

Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/ 31njury Prevention & Control: Opioid Overdose http://www.cdc.gov/drugoverdose/data/overdose.html 4Birnbaum, H. G., White, A G., Schiller, M., Waldman, T., Cleveland, J. M., & Roland, C. L. (2011 ). Societal costs of prescription opioid abuse, dependence, and misuse in the 

United States. Pain Medicine (Malden, Mass), 12(4), 657-667. http://doi.org/10.1111/j.1526-4637.2011.01075.x 

Confidential & Proprietary Information 
Confidential 

Email Message 

From: 

Sent: 

To: 

CC: 

Subject: 

Importance: 

Alec Burlakoff 

Friday, March 15, 2013 4:00:48 PM 

Sales All 

Stephanie Torres 

DO NOT DELETE! Congrats - Stephanie Bissel 

High 

Congratulations to Stephanie Bissel/ Torres 

Stephanie generated an enormous script, she has been working on this extremely hard 

for some time now. 

It just goes to show you persistence pays off! 

Stephanie just made a yearly commission from this one patient in need of our cutting 

edge medication for BTCP . 

$40,320 (one patient in need of a medication that treats BTCP with a vengeance) 

This was not luck, this was pure heart and desire! 

The best part of this entire scenario is the fact that the patient was switched from Actiq 

1600mcg. 

The physician has every intention of increasing the dose slowly but surely to 1200mcg 

in an effort to ensure the patient is being titrated effectively. 

Cha Ching again! 

I NS-BOS-00235400 
Confidential 

Email Message 

From: Alec Burlakoff

Sent: Thursday, March 28, 2013 11 :57 PM 

To: Sales RSMs; Sales All 

Subject: Q2 IC plan - follow up 

Importance: High 

Insys, 

I would like to highlight the 100 percent growth you have shown as a sales team quarter over quarter. Q 1 Launch -

1.1 Million 

Q2 - 2.5 

Q3 - 4.7 

This Quarter - 9.6! ! ! 

As you can see we expect to continually double every quarter as we have done every quarter so far. We expect at a 

minimum we each grow our territory by 25 percent in the uncapped bonus plan I just sent. The faster you get to 

lOOK, the faster your earnings will grow. We need to start fast out of the gate Monday to ensure our goal of almost 

20 million is hit. The top rep earned over 90K this quarter, who else wants some of that??? 

Sincerely, 

Alec Burlakoff 

I NS-BOS-00235599 
Confidential 

Email Message 

From: 

Sent: 

To: 

Subject: 

Sales 

Alec Burlakoff 

Monday, March 24, 2014 5:40:38 PM 

Sales All 

Top 20 Base Bonus for Q2 - assuming no growth in Q2 

The MOTTO has always been, INSYS only wants the best of the best and greatly 

desires to PAY the best of the best. Relative to compensation there has been some 

questions regarding whether lnsys will continue to PAY its top reps. 

Please see below. 

The graph depicts the top 20 reps and their projected payouts for 02 if they only 

maintained their base of business and achieved 100% eligibility for their bonus. What it 

does not show is the 10% commission for every script that a rep achieves over 100% 

eligibility that lnsys WILL HAPPILY CONTINUE TO PAY. 

Here is another way to look at it. The BOTTOM SSP on this list essentially makes 20k 

a quarter plus a 40k base which equals 140K for only maintaining the base of 

business. This is ridiculously unheard of in the industry - BUT TRUE FOR INSYS! 

As you were all made aware of numerous times during the interview process, our model 

is solely focused on rewarding the top performers. 

Be a top performer at lnsys, and we will make sure you never want to leave. As for the 

rest of you, I wish you the very best of luck in your quest to be in the top 20 percent. 

After all, it's the top 20 percent that continues to bless lnsys with 80 percent of the 

company's growth on a quarterly basis. 

I NS-BOS-00241138 
Confidential 

Email Message 

From: 

Sent: 

To: 

CC: 

BCC: 

Alec Burlakoff 

Thursday, October 03, 2013 7:18:49 PM 

Sales DMs; Sales RDs 

Sales All 

Desiree Hollandsworth; Matthew Napoletano 

Subject: Interviewing new potential hires/ coaching existing lnsys sales representatives 

Importance: High 

Management team 

( I am copying in the sales force purposely ) 

As ALL of you know, my personal feeling is that lnsys speaker programs are the single 

most important thing we have the luxury of doing here in order to promote our product. 

The opportunity to have physicians from our esteemed speakers' bureau provide an 

educational based program to his or her colleagues is priceless! 

Although our sales organization is well educated, nothing is more powerful that a 

physician's lecture to his or her fellow physicians. 

With this being said, these programs will come to a screeching halt if not done properly. 

Based on the fact that I hold these programs in such high regard, I will not allow lack of 

'focus and attention to detail' to impede this initiative. 

So, the only answer is to hire sales people that can do these programs the right way! 

When interviewing, you need to explain that their single most important function will be 

facilitating speaker programs. 

1. 

2. 

They must be able to work at-least 3 nights a week 

They must be able to recruit viable clinicians whom have the potential to treat 

I NS-BOS-00259439 
Confidential 

BTCP for every single program! 

If they do not possess the skills to recruit and confirm viable attendees / do NOT 

hire this person under any circumstances! 

I don't care if he or she is a Nobel prize winner, they will NOT be successful here 

( as ISP's are an absolute must with a scheduled 2 opioid) 

3. They must be administratively STRONG, as they must obtain a signature and NPI 

# for each attendee before they leave the speaker program. 

They are expected to submit this paperwork within 24 hours of the program. 

4. There are no 'short -cuts' here, either they can do this or they cant. 

5. Many sales people acknowledge the fact that they can't do this for one reason or 

another, so they simply avoid booking programs. 

This is NOT the answer / nor is it an option 

6. Speaker programs are a MUST, so only hire those whom can fulfill these 

necessary requirements 

7. I want MORE speaker programs now than ever, so those who can't do it or 

choose to avoid the ISP's - must not be hired. 

Lastly - everything I mentioned above applies to our current lnsys sales 

representatives. 

1. If you determine that they are not doing more programs now than ever before; 

because they can't fulfill their administrative responsibilities - they must be terminated 

from lnsys. 

2. Any current sales representative that you identify as incapable of facilitating a 

program while at the same time performing the necessary administrative task that 

accompany this luxury- they must also be terminated. 

Programs are imperative, these ISP's are the foundation for our sales and marketing 

campaign. 

I NS-BOS-00259440 
Confidential 

Email Message 

From: Alec Burlakoff

Sent: Thursday, March 14, 2013 10:52 PM 

To: Mike Gurry 

Subject: FW: re-allocation 

Attachments: NE_Exp_YTD.docx 

Importance: High 

From: Alec Burlakoff 

Sent: Thursday, March 14, 2013 2:38 PM 

To: Frank Serra 

Cc: Desiree Hollandsworth 

Subject: re-allocation 

Importance: High 

Frank 

Why are we allocating money to each rep for programs. Half of your reps do not produce, why give 

them program dollars? 

I am trying to make statement here, all in the world of business ( is NOT fair) 

Please reallocate these funds accordingly ... 

Some reps should have zero speaker dollars, others maybe Sk ( to give them a 2nd chance to prove 

themselves worthy of ISP dollars) 

The discrepancy of allocated ISP funds should vary greatly between the top reps to the bottom reps. 

I am tired of giving money to reps whom produce zero return on investment. 

Those whom do not produce ROI from programs should not be spending our ISP dollars ..... . 

Lastly, look at the cost per program for some of these reps. 

What the hec are they spending all this money on? 

I need the reps whom can get the most bang for their buck using our money. 

Please assist ...... . 

Alec 

I NS-BOS-00276257 
Confidential 

Email Message 

From: 

Sent: 

To: 

CC: 

BCC: 

Subject: 

Attachments: 

Good evening 

Alec Burlakoff 

Wednesday, December 19, 2012 11 :07:49 PM 

Sales All 

Michael Babich 

Daily Rep Report for RX 12-18-2012.xlsm 

photo.JPG; Subsys Top 50 witers 12.1.12.xlsx; Daily Rep Report for RX 

12-18-2012.xlsm 

Please find the attached daily Subsys prescription report for yesterday's activity. 

I am extremely pleased with the most recent results you have produced ( as it pertains 

to the lnsys daily prescription count and total net sales) 

If ( for whatever reason) you find that you had a day where you did not produce a 

prescription, ask yourself a few questions ... 

i.e. 

- What have I done different than that of all the other representatives calling on these 

physicians? 

- Am I TRULY thinking 'out of the box'? 

-What am I doing aside from visiting the doctor's office on a routine basis to generate 

the business? 

-What have I done to be seen in a different light? 

- How do I transition from the doctor viewing me as 'the Subsys representative' to 'Alec 

- my friend in pharmaceuticals'? 

- Have I really FORCED myself to step 'outside' of my comfort zone? 

I NS-BOS-00396918 
Confidential 

Please see the attached picture ..... 

Although you may find some humor in seeing me attempt to workout, this is truly not 

meant to be a joke. J 

I am 100 percent serious when I tell you, if you have not found a way to spend time with 

your customers OUT OF THE OFFICE AND NOT IN A RESTAURANT ( its simply not 

good enough) 

( RESTAURANTS ARE WHERE EVERY PHARMACEUTICAL REPRESENTATIVE 

SPENDS TIME WITH THEIR CUSTOMERS ) 

its "ok" - but it is definitely 

NOT different 

You have to discover a way to be different, think differently, and do something different 

in order to generate a loyal Subsys customer. 

This is the customer whom will NOT let you down, he or she WILL always find a way to 

make sure you get a least 1 Subsys prescription per day! 

Lastly, I was at the gym with Dr. Steve Fanto and his local Subsys pharmaceutical 

representative Brianna Smith this early afternoon. 

Dr. Fanto is currently the fifth largest Subsys 'net sales' generator to lnsys. 

This is in FACT quality time with a 'key' physician on his lunch hour. 

Do you think he might be inclined to be thinking about prescribing Subsys , when he 

goes back to the office to see his afternoon patients? 

I have also attached the lnsys report of our top 50 prescribers as of 12-12-12. 

If you happen to notice one of your doctors on this list along with Dr. Steve Fanto (#5), I 

would sincerely suggest your finding a way to see this physician out his or her office. 

I NS-BOS-00396919 
SUBSYS Incentive Compensation Plan 

Q2 2013 

Confidential I NS-BOS-00406275 
m Reward high performers, and reduce the payout to lower tiers 

m For each net sales "bracket", payout% gets progressively higher. For 

example, the first $60K net sales gets a 5% payout rate, net sales 

between $60K - $100K gets 8%, etc. 

m High dose (1200 and 1600MCG) still gets the highest payout rate 

m Keep focus on expanding writer base (kicker for exceptional 

performance on activating the writers) 

m New hires (those started their first day with lnsys in Q4'12 or Q1'13) 

will have a simplified IC plan instead 

For internal planning purposes only 

Confidential I NS-BOS-00406276 

2 
Confidential 

-

l'H··:•.::lllllii,lit~:1 

• We will communicate to you the# SUBSYS writers you need 

to clear the Writer gate 

For internal planning purposes only 

I NS-BOS-00406277 

3 
Confidential 

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••••r..1••e•w••••••••e•A1•1••e•r..1•m••••••••1••11••1••1•1•A1•1••m•r..1• •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••1••1••1•••••••••••••••••••••••••••••••••••••••••••••••••••••·························· 

RXer Special Bonus (If 

>=35o/o of All ROO Rxers 

Write Subsys AND 

>=$150K Net Sales in Q2) 

................................................................. 

10°/b Extra 

Payout (Subiect 

To $2K Cap) 

For internal planning purposes only 

I NS-BOS-00406278 

4 
Confidential 

· • · · ·... .,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,l,.,.,.,.,.,.,.,.,.,.,.,.,.,m,.,.,.,.,.,.,.,.,.,.,.,.,., .• " •. ,., •.• _••.•.•,.,.,.,.,.,.,a,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,l,.,.,.,.,.,.,.,.,.,.,.,.,.,1,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,

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RXer Special Bonus (If 

>=35o/o of All ROO Rxers 

Write Subsys AND 

>=$1 SOK Net Sales in Q2) 

10°/o Extra 

Payout (Subiect 

To $2K Cap) 

For internal planning purposes only 

I NS-BOS-00406279 

5 
NET SALES Ql PAYOUT Q2 PAYOUT 

$60K $6K $3K 

$100K $10K $6.2K 

$150K $16K $11 K 

$200K $22K $16K 

$250K $28K $22K 

$300K $35K $28K 

Payout Ratio: 6 9.4 $300k:$60K 

For internal planning purposes only 6 

Confidential I NS-BOS-00406280 
Confidential 

Email Message 

From: 

Sent: 

To: 

Cc: 

Subject: 

Attachments: 

Importance: 

Hello 

Alec Burlakoff < > 

Monday, July 22, 2013 5:30 PM 

Sales RSMs 

Sales All; Mike Gurry; Michael Babich; Matthew Napoletano; Richard Simon 

URGENT - 30 Day Pip 

Over a week fills.xlsx 

High 

Please see the attached and click on the first tab labeled ( RSM ) 

If you see a comment in where you should have inputted your follow up ( as requested), you are 1 week away from a 30 day pip. 

The top 30 reps will stay with lnsys, the bottom 30 whom cant comply with a simple request should be actively looking for a replacement job. 

I continuously hear how hard everyone is working. 

We are not in the construction business, you don't get paid to work hard - you get paid to produce results. 

Furthermore - you are expected to work smart. 

Your decision to not be in the office face to face the very next day after a first time prescription is NOT working smart, STOP WITH THE DAMN 

OHONE NONSENSE! 

Now, those who fail to comply will not be working at all. 

Fridays, we literally do half in sales as the other 4 days. 

Every rep that does not produce a script two consecutive Fridays will also be placed on a PIP, considering 1 rx per day has been the goal for over 

a year 

( this should NOT be of concern to those who work, develop relationships, and have their 'go to' offices IN PLACE. 

Below is the list that failed to produce this past Friday, if you are on this list you must produce 1 single script this Friday to avoid a PIP. 

All of you are saying "what's with the scare tactics", that's no way to motivate a sales force! 

LET ME BE CRYSTAL CLEAR 

I NS-BOS-00407939 
I'm not trying to motivate anyone, I am truly trying to get rid of those reps whom choose or simply can't follow direction. 

You want a cheerleader? 

Your with the wrong company. 

We are here to WIN and get paid, not run pep rallies. 

Jenna 

Please understand that we have a goal to hit, we have been just missing Fentora for the past 6 weeks. 

We won't catch Fentora working 4 days a week. 

I need to get a full sales force here at lnsys that can get it done. 

I apologize, but we are going to have at least 15 reps on a PIP by next week. 

SSP Activity Week of 7 /20/13 

Data Date: 7/19/2013 Fri 

.... 

Dr Last #TIMES ON 

SSP Name RX in DAY Name # DOSES STRENGTH GROSS$ NEW/REPEAT SUBSYS 

CHI CHl-103 April Moore N 0 0 0 

CHI CHl-106 Brett Szymanski N 0 0 0 

CHI CHl-109 Stephanie Torres N 0 0 0 

DAL DAL-101 Avery Aboud N 0 0 0 

DAL DAL-102 Diana Maldonado N 0 0 0 

DAL DAL-105 Shannon Paradis N 0 0 0 

MIA MIA-104 Lilian Logatti N 0 0 0 

MIA MIA-109 Brittany Williams N 0 0 0 

NYC NYC-101 Michael Volansky N 0 0 0 

NYC NYC-105 Jonathan Roper N 0 0 0 

Confidential I NS-BOS-00407940 
Confidential 

Email Message 

From: 

Sent: 

To: 

CC: 

BCC: 

Subject: 

Attachments: 

Hello lnsys! 

Alec Burlakoff 

Monday, September 17, 201211:06:44 PM 

Sales All; Sales RSMs 

Michael Babich; Matthew Napoletano 

30 Unit Effective Dose Savings Program - Live Wed 9/19 

Daily Rep Report for Low Strength.xlsm 

After today's conversation in the home office, I felt it to be imperative that I send you an 

e-mail pertaining to the below correspondences you will be receiving on a daily basis. 

As you know by now, you will receive an e-mail (example below) each and every time a 

presciber in your territory writes for a Subsys prescription at 1 OOmcg or 200mcg. Please 

utilize the attached spreadsheet prepared by Darin Fila (West, Regional Sales 

Manager ) to report back within 24 hours on WHY the low dose was used and HOW 

the doctor plans to titrate the patient to effective dose .. You do not need to fill out 

every column, but the responses we are receiving thus far are just much too vague in 

order to allow us to formulate any worthy level of understanding behind the clinician's 

action. I fully understand that a physician does what he or she wants to do as it pertains 

to prescribing for their patients. I am thrilled to see you are all generating so many 

Subsys prescriptions! I know it is not at all easy to get a physician to initiate a new habit, 

and this is exactly what we are attempting to do. 

So, you are most likely asking "why is the company harassing me on a daily basis, for 

doing a great job?" 

Each new Subsys patient should be started at 1 OOmcg, per the package insert. 

To be clear, the last thing we want you to think is that we are harassing you for 

generating sales. What we are attempting to do is; help you to maintain these newly 

generated Subsys patients by rapidly informing you of the fact that they wrote for a dose 

and number of units that is simply NOT effective. We are 100 percent sure that those 

patients whom are prescribed 60 units of 1 OOmcg, do not end up filling a prescription for 

Subsys the following month. This is information that we feel obligated to share with you, 

as there is no good at all that comes out of withholding the very data that will determine 

your quarterly bonus payouts. We understand that you are not out here to just give 

away free product, we know that your goal is the same as ours. The goal is to generate 

I NS-BOS-00486492 
Confidential 

Subsys patients whom believe in the safety and efficacy behind this product, hence 

these patients will continuously refill their monthly prescriptions indefinitely. This of 

course equates to residual income for you! This is how you reap the rewards for your 

unsurpassed efforts in the field on a daily basis. There is nothing more frustrating to a 

salesperson whom makes a sales, only to learn that the sales was 'returned' shortly 

then after. This in essence is exactly what is happening with the majority of all patients 

put on Subsys at 1 OOmcg ( 60 units). 

In the case you as a sales person are earning a commission for a sale made, only you 

have that commission revoked due to a return of product the following month. You are 

spinning your wheels, due to the fact that these physicians are writing for an inferior 

dose. Hence our infatuation and obsession with the 'EFFECTIVE DOSE' message. We 

must educate our physicians how to ensure their patients find the 'EFFECTIVE DOSE'. I 

will go as far as to say that we are truly better off dissuading a physician to prescribe 

Subsys for 100 and 200mcg until we have had ample time to review how clinical trial 

data with them via the Rauck study. After all, you only get once chance to make a first 

impression, is this the lackluster impression we want to make for our superior product? 

We will of course be discussing this subject matter in far greater detail at this upcoming 

meeting! We will do so, because we will inevitably fail miserably if we do not vehemently 

drive home the EFFECTIVE DOSE message on every sales call. You as a sales force 

are way to talented and hard working to fail due to an inferior dose being prescribed. 

We have a tremendous product and an even better team of sales representatives. 

Together - we will utilize every single piece of data, feedback, clinicals, information, etc. 

to get the job done and reap the rewards of our unprecedented efforts! 

Good selling! 

Alec 

EXAMPLE of Daily 'Low Dose' E-Mail 

I NS-BOS-00486493 
Email Message 

From: Alec Burlakoff

Sent: Monday, February 04, 2013 I :32 AM 

To: Mike Gurry 

Subject: Fw: Letter of Concern regarding Rich as a manager! 

Sent via BlackBerry by AT&T 

-----Original Message-----

From: 

Date: Fri, 1 Feb 2013 11:09:52 

To: Alec Burlakoff

Subject: Letter of Concern regarding Rich as a manager! 

Alec: 

So I've worked for Insys for 2 months now and I understand being under the gun and the intentions of getting Mary 

Jean's Actiq switches as quickly as possible and trust me I get the huge potential Mary Jean is. However, I have 

talked to her multiple times regarding sitting down and identifying Actiq switches and helping out to get their prior 

auth's done for them and opt-in any and all patients that this product is applicable for on numerous occasions which 

Rich is very aware of. I have also let Rich know that Mary Jean can not be bought, forced, coerced, bullied, or 

anything else into writing any product. I have lived with Mary Jean for 10 weeks and have developed a great 

relationship with her. I have met her husband, been shown numerous photos of her grandson, invited to her tap 

classes on Thursday nights, and so forth and can tell you that Mary Jean will be a great advocate for Subsys on her 

own time frame and it will take time. You've had 3 reps now in this territory in 9 months--Tara, Jacqueline, and me 

which the doctors know all of our names and ask what happened to the other rep?? These other 2 reps obviously 

worked just as hard as I've been working and ran into the same scenerio which is Mary Jean can't be bought, bullied, 

manipulated, or anything else. I'm including her last response that I made an effort to try and work with Audrie her 

prior auth specialist even while she's on vacation to get switches identified and even talked to her about how I'm 

Hippa compliant several times, but that's not comfortable to her. I have been working my butt off with my top 

doctors and I get the frustration of them not jumping on board with this great product, but just because they aren't 

coming along as quickly as possible, doesn't mean I'm not making great progress and getting scripts. I get the 

frustration--- trust me and I have expressed to Rich, but this frustration of doctors not coming around quick enough 

does not warrant the unprofessional and unacceptable behavior that Rich Simon my manager has been 

demonstrating through his emails, calls, and texts. Nothing seems to be right in his opinion that I am saying or 

doing, and I've been a rep for over 5 years and have had 6 different managers (all of whom were fantastic managers) 

and have won multiple awards on many different products and have never once been treated so unprofessionally, 

and in such a hostile working environment. I sincerely question if Rich Simon has ever been a manager before this 

job and do not believe he has management qualities nor temperament for the current position he is in with Insys. Let 

me give you some examples that have been so concerning: 

If Rich has a concern with a situation he doesn't know how to respond appropriately and instead shoots back in a 

derogatory or demeaning manner with either a hostile statement or question----ex. Rich is in working with me on 

Wednesday and we finish our meeting with Dr. Saxton and get to the parking lot@ 11: 15 where the subs are to be 

picked up for the luncheon which happens to be right in the same parking lot as Katie Toledo's office and seeing that 

we have 45 mins, I say to Rich "Hey let's go make a call on Katie Toledo since we have time right now" and Rich 

ignorantly begins to chew me out by saying, "why would you suggest that? Do you not listen when we are talking to 

you about JUST spending time with your top 4 docs and forget about these other distractions!" I tum to Rich and 

say, "are you really going to chew me out and be mad at me because I am suggesting to utilize these 45 minutes to 

the best I can and take this opportunity to have the office throw out the expired vouchers and leave them new ones 

and maybe get the opportunity to speak to Katie Toledo (decile 6 target) and try and generate a script? I mean 

Confidential I NS-BOS-00495776 


Confidential 

Email Message 

From: 

Sent: 

To: 

BCC: 

Subject: 

Importance: 

Attachments: 

Sales 

Alec Burlakoff 

Tuesday, March 19, 2013 5:36:53 PM 

Sales All 

SUBSYS Relay Weekly QuickView - Week Ending 03/15 

High 

SUBSYS Relay Weekly Quickview 2013 0315.xlsm 

Please see the attached .... 

It is nothing you have not heard me say a thousand times. 

I know you are sick of hearing it; but I have to keep saying it ( because it continues to be 

proven over and over again.) 

The below 5 names mentioned at the top of the company rankings - literally have their 

entire business being driven by basically 1 customer. 

This is NOT luck and it is not due to any special advantage these sales people have 

been given. 

These sales people, did what most are not able to do! 

They found a customer to 'own', and they packed the proverbial suitcase and moved in. 

It takes more than one customer to sustain long term success, but you will NOT achieve 

success w/o the 1 customer - you must create! 

The names mentioned below earned every single penny they will be getting paid. 

In fact - I say they should be paid more , because they proved that finding this one 

customer is not as easy as one might think. 

I NS-BOS-00589621 

Confidential 

anyone who claims these people were lucky are 100 percent wrong, this is a promise! 

Own your territory - own a doctor - and own your destiny ........ . 

Alec 

From: Xun (Sean) Yu 

Sent: Monday, March 18, 2013 2:33 PM 

To: Michael Babich; Matthew Napoletano; Alec Burlakoff; Mike Gurry 

Cc: Ashok Chavan; Willene Brondum; Larry Dillaha; Maury Rice; Jenna Grosshans; 

Dion Reimer; Linda Keelan; ; Venkat Goskonda; Bryan Waltrip; 

Frank Koppenhagen; Neha Parikh; Stacy Ruggiero; RelayReporting 

Subject: SUBSYS Relay Weekly QuickView - Week Ending 03/15 

Importance: High 

This report is a standard weekly delivery every Monday utilizing Relay report. It 

represents the most recent/accurate view of SUBSYS business and is generally 1-2 

days delayed. Please let me know if you would like to see other topics covered. 

Suggestions/comments are always welcome. 

Highlights for the last week: 

1 ), Generated $1244K new high gross sales = $64. 7M annual run rate; Generated 

$1108K new high "Net" sales= $57.6M annual run rate 

2), Dispensed 316 TRx, including 17 "Super Vouchers". Thumb of rule each 20 

TRX/week = 1% TIRF market share 

3), "Net" sales at 89% of the gross WAC revenue 

4), Doses/RX at 65.6/script. Blended pricing at $60 

5), 75% Scripts generated last week were from repeat patients, 25% from new 

patients 

I NS-BOS-00589623 
Confidential 

Email Message 

From: Richard Simon ] 

Sent: Wednesday, October 02, 2013 10:15 PM 

To: Sales DMs 

CC: Sales RDs; Alec Burlakoff; Desiree Hollandsworth 

Subject: Ql-2-3 Missing ISP post documentation/Administrative Responsibilities 

Attachments: ALL_ Q l _ 2 _3 _ MISSING _PROGRAM_ INFO For Rich.xlsx 

Importance: High 

District Managers, 

It has been brought to my attention that the vast majority of the managers have failed to motivate their 

SSP's properly to be on time with their administrative responsibilities. 

Managers administrative responsibilities are to include at the very least: 

1. Post ISP paperwork 

2. Expensereports 

It is simply unacceptable to go quarter after quarter without ensuring that your SSP's are on time with 

documentation that is scrutinized internally at the highest level. This also creates additional 

administrative work for our internal customers at the home office that distracts from their ability to 

support us where we need our support the most. 

What drives us all? COMPENSATION 

Moving forward: 

For Q4 

• Managers that are OVER.90% efficient with these responsibilities will receive a 5% kicker over 

and above their quarterly bonus 

• Managers that are UNDER.SO% efficient with these responsibilities lose 5% of their quarterly 

bonus 

For Q3 

• We are still evaluating what if any punitive actions will be taken for any failure of your SSP's to 

get their administrative paperwork in. So PLEASE get your reps up to speed and on the ball with 

their administrative responsibilities NOW so the management team isn't forced to take any 

punitive actions for Q3 payouts. 

Attached is spreadsheet that outlines each program missing information. 

Highlighted below are the major offenders relative to submitting their post ISP paperwork for Ql,2 and 

3. 

It's not a pretty site. 

I NS-BOS-00986277 
Email Message 

From: Alec Burlakoff 

Sent: Wednesday, October 09, 2013 9:18 PM 

To: Sales RDs; Sales DMs 

Subject: Muy Interesante! 

Importance: High 

Management team 

Please see the below, I have taken the liberty of highlighting some key 'ROO' prescribers whom have failed us tremendously. 

I am not sure that any of us need to analyze any additional reports, as this report pretty much provides us the 'roadmap' to success or failure. 

Focus on the big ROO writers whom are giving us less than 50 percent, demand the business that you have worked so hard to EARN. 

Ask yourself a few questions and then proceed forward accordingly ......... . 

1. Did we do enough to earn more than 50 percent of their ROO business? 

2. If so, did we have a 'heart to heart' with our customer to address our valid concerns pertaining to the lack of business we are currently getting? 

3. If we had the 'heart to heart' and we are still not getting more than 50 percent, why the hec are we still spending the majority of our time and resources 

there!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 

Way too much business left on the table, please address each rep individually and light a fire under them. 

We are sales people .... Sales people have pride ............ Our pride has to be hurting big time as a direct result of some of these doctors prescribing habits ... . 

Alec 

0250784009 A WERBUCH, GAVIN, Ml 

2434688001 RUAN, XIULU, AL 

XMS232862 

6 $©1N~%~Rlgfl<:m 

048148817 5 SOMERVILLE, JUDSON, TX 

Confidential 

$ 

3 

$ 

4 

$ 

5 

$ 

8 

$ 

2,075,89 

592 

1,655,84 

400 

1,57 4,40 

361 

1,398,00 

606 

1,298,25 334 

$ 

568 96% 2, 185,133 

$ 579, 16 

180 45% 7 

$ 651,80 

246 68% 2 

$ 1 84,98 

226 37% 0 

286 86% $ 

Brett Szymanski 10 8 10 NEUROLOG 

NW,eltfMiitke 10 10 8 ANESTHESIC 

Natalie Perhacs 10 10 9 ANESTHESIC 

EdlU#G.titte# 10 10 7 OTHER 

Ty Rustin 10 9 ANESTHESIC 

I NS-BOS-00987019 
1 3 

$ 390,22 

0480491020 BURTON, ALLEN, TX 4 83 0 0% $ Amy Bender 9 9 ANESTHESIC 

$ 378,69 $ 82,29 CodiAnne 

0000056314 BEDELL, RAYMOND, UT 9 70 33 47% 6 Christensen 8 7 4 ANESTHESIC 

$ 369,03 PHYSICAL Ni 

0350892188 VALENZA, JOSEPH, NJ 0 58 0 0% $ Sandy Wong 8 9 0 REHABILITAT 

$ 358, 14 $ 315,65 

1650178002 WAND, PAUL, FL 7 1 36 1 17 86% 2 Lilian Logatti 8 8 5 NEUROLOG 

XMA238439 $ 356,69 $ 75,90 

5 A4FQN§@J••HeArHeRJ••qr 9 145 68 47% 2 Natalie Levine 9 7 2 OTHER 

$ 343,50 $ 1 17, 16 

0190296056 MlfaN~ARi••$1§¥§Nir$A 4 219 73 33% 9 Myles Walsh 9 5 5 ANESTHESIC 

$ 343,29 PHYSICAL Ni 

65401 81005 CARABELLI, ROBERT, NJ 7 66 0 0% $ Lauren Hanley 9 8 REHABILITAT 

$ 334, 10 $ 66,87 

4220198057 ALLADIN, IRFAN, NJ 8 59 31 53% 7 Susan Beisler 8 9 5 INTERNAL M 

$ 307,24 $ 22,62 PHYSICAL Ni 

0350885233 $RijfNN!5Ni JIIGblmijt.) r$i 6 105 15 14% 6 Susan Beisler 9 3 3 REHABILITAT 

$ 300,70 

0230192061 GUARINO, ANTHONY, MO 7 67 0 0% $ Justin Lierz 9 9 ANESTHESIC 

$ 300, 18 $ 81,54 

0352076109 FX~Ni••Rr11t.t.1Ft•••Nx 8 82 37 45% 7 Sonia Palermo 9 6 6 ANESTHESIC 

$ 297,63 

01601 831 19 GOODMAN, IRA, IL 4 64 0 0% $ Jonas Lieponis 9 9 0 ANESTHESIC 

$ 296,73 $ 6, 16 ............................................. 

1430370024 YY'Hlfijfpijf§RI••§A 7 17 3 1 8% 1 Erika Gutzeit 8 8 ANESTHESIC 

$ 296,34 $ 1 1 8,88 PHYSICAL Ni 

0420107062 MIRANDA-GRAJALES, HECTOR, FL 3 51 42 82% 0 Robert Zarrilli 2 2 2 REHABILITAT 

$ 290,01 $ 8,04 Diana PHYSICAL Ni 

6494484001 JOSELEvrnz···· oe····rx . . %4. Mt. 3 67 4 6% 9 Maldonado 10 9 3 REHABILITAT 

$ 279,39 $ 49,73 PHYSICAL Ni 

0354780027 p1<:qf f §§R(pi••r1<:qyy15gqf •• MR 5 55 1 3 24% 7 Jessica Larichiuta 8 8 4 REHABILITAT 

$ 273,25 $ 94,20 FAMILY PRA 

0200285022 COHEN, HOWARD, TX 3 94 40 43% 5 Lance Clark 9 6 2 PRACTICE 

$ 272,99 $ 91, 1 2 

0051487025 DOMINGUEZ, MIGUEL, CA 0 67 48 72% 9 Sayra Torberson 7 4 6 ANESTHESIC 

$ 271,97 $ 239,90 PHYSICAL Ni 

0384391048 GERBER, GREGORY, OH 8 77 65 84% 5 Lisa McBride 7 3 7 REHABILITAT 

$ 271,22 $ (501 Andrew 

XML 1607792 ~A@we1•••PAMIQ; QA 3 44 4 9% ) McNaughton 7 7 2 OTHER 

$ 269,61 $ 64,95 PHYSICAL Ni 

03841 86092 J<:qN§$f ••§'XR@Nf ••s:@ 5 55 19 35% 1 Jeff Leischner 9 8 4 REHABILITAT 

XMS084206 $ 265,95 $ 21 8,06 

6 STDENNIS, RICHARD, RI 4 61 58 95% 6 Natalie Levine 4 1 5 ORS 

041 1 390172 WOLFE, WILLIAM, NJ $ 264,48 42 2% $ 1 3,48 Rachel Barrans 9 9 NEUROLOG 

Confidential I NS-BOS-00987021 
Email Message 

From: Alec Burlakoff 

Sent: Monday, September 16, 2013 8:25 PM 

To: Abe Rosenberg 

CC: Natalie Levine; Jonathan Roper; Sunrise Lee 

Subject: RE: Letter of Resignation 

Hi Abe 

Thanks for thee -mail. We will move forward with transferring Dr. Rosenberg's account over to Natalie 

Levine now. 

In addition, we will still need to backfill your vacancy. 

Can you or your dad recommend anyone? 

keep in mind that the new rep will not be servicing your dad ( as this account will belong to Natalie 

Levine - indefinitely) 

Thanks 

Alec 

From: Abe Rosenberg 

Sent: Monday, September 16, 2013 1:05 PM 

To: Alec Burlakoff 

Subject: Letter of Resignation 

Hi Alec -

Thank You for the email and the phone call today. 

I am appreciate your support and I look forward to my next chapter. 

I have spoken directly with my father again who continues to feel as though working with Natalie Levine 

would be the best option moving forward. It would be a seamless transition for him to continue to 

manage his Subsys patients and represent Insys as a Speaker. Feel free to reach out to him to discuss 

any details at his personal cell phone - . The best time to reach him will be any time after 

5pm EST. 

Again, I am grateful for the opportunity you have provided me and I hope we will cross working paths in 

the future. 

Please keep me informed with any tasks that need to be accomplished before my departure. 

Thank You, 

Abe Rosenberg 

Specialty Sales Professional 

Confidential 

Insys Therapeutics, Inc. 

I NS-BOS-00987139 
Confidential 

Email Message 

From: Alec Burlakoff 

Sent: Saturday, August 31, 2013 2:58 PM 

To: Sunrise Lee 

CC: Beth McKey; Joseph Rowan; Richard Simon; Michael Babich 

Subject: Fw: List of Key Clinicians to target 

Nice job Sunrise, thank you for your timely response .... 

Alec 

Sent from my BlackBerry 10 smartphone on the Verizon Wireless 4G LTE network. 

From: Sunrise Lee 

Sent: Friday, August 30, 2013 9:30 PM 

To: Alec Burlakoff 

Subject: List of Key Clinicians to target 

Primary Targets 

1. Gavin Awerbuch, Ml 

1. Gordon Freedman, NY 

2. Jeffrey Goldstein, NY 

3. Jerrold Rosenberg, RI 

4. Paul Madison, IL 

5. Harvey Finkelstein, NY 

6. Romanth Waghmarae, NY 

7. Alexander Weingarten, NY 

8. Phillip Fyman, NY 

9. Heather Alfonso, CT 

10. John Milnor, TN 

11. Gladstone McDowell, OH 

12. Daniel Salcedo, NY 

13. Riad Laham, OH 

14. Anthony Mimms, IN 

15. Michael Brennan, CT 

Secondary Targets 

1. Gregory Gerber, OH 

2. Richard St. Dennis, RI 

3. Hammam Akbik, OH 

4. Serge Menkin, NY 

5. Roger Kasendorf, NY 

6. Nilesh Jobalia, OH 

7. John Kelly, KY 

8. Mitchell Weisberg, IL 

9. Bruce Durell, IN 

10. Kevin Hastings, NY 

I NS-BOS-00987172 
Email Message 

From: 

Sent: Wednesday, June 19, 2013 8:08 PM 

To: Jeff Pearlman 

Subject: Re: watch out 

Nice!!!!!!!!!!!! 

On that note, keep an eye our for Dr Furchansky in Houston. I had dinner with him last night.. : ) 

Sent via BlackBerry by AT&T 

Confidential 

From: Jeff Pearlman 

Date: Wed, 19 Jun 2013 12:59:58 -0700 

To: Alec Burlakoff

Subject: watch out 

Probably not what you are thinking from the title, hehehe. 

After my trip yesterday and today I am telling you to watch out for Heather Alfonso(Abe's). Of 

course I am thinking KOD as I type this, but wouldn't be the sales person I am if I didn't believe 

in what I think I just accomplished and what I expect to see. 

Time will tell. 

Jeff Pearlman 

Regional Sales Manager 

INSYS Therapeutics, Inc. 

I NS-BOS-00988849 
Email Message 

From: Alec Burlakoff 

Sent: Wednesday, May 08, 2013 10:30 PM 

To: Richard Simon 

CC: Michael Babich; Sales RSMs 

Subject: FW: what is it going to take? 

Importance: High 

GREAT e-mail! 

From: Richard Simon 

Sent: Wednesday, May 08, 2013 3:07 PM 

To: Sales Team - SFO 

Cc: Alec Burlakoff 

Subject: FW: what is it going to take? 

Importance: High 

Team, 

A RESPONSE IS WARRANTED HERE: 

1. Please look at this list. Look at the TWO top potential people on this list that are underperforming within your geography and please respond what your plan 

is to turn this around. 

2. If there is a reason the top two people on the list shouldn't be your GO TO doctor please explain and have TWO OTHER doctors that you share your plan to 

grow their business. 

3. Please provide the current market share of the two doctors you have chosen with rationale as to why you have chosen them so we can track your progress 

4. If your top doctor or two are NOT highlighted because you have done extremely well with your top two physicians, then please let me know first and 

foremost their market share so you can be recognized for your efforts. And also be working on your backups! 

OUR ULTIMATE GOAL IS TO HAVE A LIST FULL OF PEOPLE ON OUR TEAM WHERE WE CAN CELEBRATE ALL OF YOUR EFFORTS FOR THE HARD WORK YOU HAVE 

DONE. AND MAKE NO MISTAKE WITH EVERY HIGHLIGHTED PHYSICIAN THERE IS AN OPPORTUNITY TO MAKE AN IMPACT. 

Thanks, 

Rich 

From: Alec Burlakoff 

Sent: Wednesday, May 08, 2013 2:11 PM 

To: Sales All 

Cc: Michael Babich 

Subject: what is it going to take? 

Importance: High 

Sales 

Please see the below report, I have sorted it from the largest 'ROO' prescriber down to the smallest. 

I look at some of these names, and I just can't believe that we do not get at least 50 percent of their ROO business. 

Confidential I NS-BOS-00989340 
XMW1252179 WILENSKY, BONNIE, CO $ 220,510 39 2 $% $ 23,189 Crystal Skelton 9 10 3 ANE 

0472094008 BHAKTA, BHADRESH, OK $ 216,910 82 0 0% $ Casey Hanoch 9 ANE 

Michelle 

6540197098 PATHARKAR, MANOJ, NJ $ 216,818 53 46 87o/o $ 58,532 Breitenbach 7 0 6 AP/v 

Michelle PHY 

3060197021 SIDDIQUI, ASMA, NJ $ 214,088 43 0 0% $ Breitenbach 8 8 0 REH, 

PHY 

0350892188 VALENZA, JOSEPH, NJ $ 212,908 49 0 Oo/o $ Sandy Wong 9 9 0 REH, 

PHY 

4220102167 SINGH, RAMNIK, CA $ 210,618 39 0 0% $ Sayra Torberson 6 4 REH, 

Andrew 

XML 1607792 LAGUE, DAVID, CA $ 207,972 34 3 9% $ 15,945 McNaughton 7 7 2 on0160275079 STERLING, MELVYN, CA $ 206,913 91 33 36o/o $ 57,838 Sayra Torberson 7 7 2 INTE 

0481282007 AVILA, FERNANDO, TX $ 203,441 84 3 4o/o $ 6,242 Ty Rustin 9 7 ANE 

Katarina PHY 

7481683016 SALCEDO, DANIEL, NY $ 203,292 57 4 7o/o $ 18,006 Haumesser 9 8 REH, 

5500281012 FINKELSTEIN, HARVEY, NY $ 202,903 74 32 43o/o $ 125,803 Sonia Palermo 9 5 ANE 

FAN 

0051983018 COSTELLO, LLOYD, CA $ 200,646 60 5 8o/o $ 2,193 Lisa Bailey 7 6 PRA 

0352076109 FYMAN, PHILLIP, NY $ 200,091 68 23 34o/o $ 96,466 Sonia Palermo 9 6 6 ANE 

4953982003 SINGH, VIKRAM, CA $ 198,080 57 14 25o/o $ 5,239 Brook Smets 9 8 2 ANE 

9150278047 MASHALi, FA THALLA, RI $ 197,081 43 2 5o/o $ 3,672 Abe Rosenberg 8 0 0 cc~ 

PHY 

3050183031 SIMON, STEVEN, KS $ 196,882 49 40 82o/o $ 145,690 Torgny Andersson 7 4 6 REH, 

0560685070 HESS, CARL, CA $ 191,148 43 0 Oo/o $ Lisa Bailey 8 5 ANE 

PHY 

0000040377 HARTMAN, STUART, PA $ 189,800 40 0 Oo/o $ Kristen Ogg 9 3 0 REH, 

1650178002 WAND, PAUL, FL $ 186,071 41 14 34o/o $ 44,472 Lilian Logatti 8 9 0 NEU 

CodiAnne 

0000056314 BEDELL, RAYMOND, UT $ 184,627 44 14 32o/o $ 11, 147 Christensen 8 7 5 ANE 

0000034809 MATTHEWS, PHILIP, WA $ 183,764 27 19 70o/o $ 84,640 Kristiana Wright 9 6 5 ANE 

PHY 

5500296009 ELFENBAUM, MARCIA, CA $ 182,851 32 0 Oo/o $ 894 Colt Woods 9 3 0 REH, 

0250780196 ROSS, EDGAR, MA $ 180,657 45 0 Oo/o $ Natalie Levine 8 9 0 ANE 

Confidential I NS-BOS-00989344 
Email Message 

From: Matthew Napoletano 

Sent: Friday, October 25, 2013 6:45 PM 

To: 

CC: John Kapoor Michael Babich; Vikram Malhotra; Mark Hein; Alberts, David S - ) 

Subject: Panels 

Importance: High 

Des, 

Here are the comprehensive list of panels for lnsys. Please work on compliant justification documents and contracts ASAP. We will put in $500/hr as a place holder 

(JK may want to offer a flat fee instead). Note 1 and 2 below require a T-Con Ad Board ASAP. 3-5 below require recruiting for an oral solution panel. JK would also 

like to choose 3 or 4 people from 3-5 below and establish a mixed specialty cannabinoid ad panel. We can discuss further when we meet. Regards --- Matt 

1. Pain Practice Steering Committee - Please set-up a T-Con call for next week to discuss Nucynta (Vik and I put together questions and already spoke to 

Nicholson and Kesten) 

Bruce Nicholson 

Michael Brennan 

Jeffrey Kesten 

Bart Gatz 

Gorden Freedman 

Mark Gerber 

Forrest Tennant 

Ken Sun 

Romanth Waghmarae 

Steve Simon 

Jerrod Rosenberg 

Louis Spagnoletti 

2. Oncology Steering Committee - Set-up a T-Con ASAP to discuss marketing to patients and then a live meeting 3rd week in January 

First Middle 

Name Initial Last Name Degree Ins itution/Practice City State 

Susan Nolte RN,PhD Abington Memorial Hospital Philadelphia PA Nurse One, Chair, GOG NL 

Robert Figlin MD Cedars Sinai CA 

George Demetri MD Dana Farber Cancer Center Boston MA Head Sarcoma 

Laura Havrielesky MD Duke University Cancer Institute Durham NC Gyn One, Pharmacoecon I 

Lawrence Einhorn MD Indiana Unversity Cancer Center Indianapolis IN Testicular & Lung Ca, inte1 

Richard Gralla MD Jacobi Med Center New York NY Antiemetics top KOL 

Charles Loprinzi MD Mayo Clinic Rochester MN Supportive Care 

Confidential I NS-BOS-0098967 4 
Fadi Braiteh MD,CPI Comprehensive Cancer Centers of Nevada Las Vegas NV Supportive Care, GI Ca, re 

Martee Hensley MD Memorial Sloan Kettering Cancer Center New York NY Med Gyn One, HEOR/QoL 

George Sledge MD Stanford Univ CA Oncologist, breast Ca, pas 

Theodore Lawrence MD, PhD Univ of Michigan Comprehensive Cancer Center Ml Chair, Rad One 

Edward Bruera MD, FAAHPM Univ of Texas, MD Anderson Cancer Center Houston TX Supportive Care 

Nancy Davidson MD UPMC Cancer Center Pittsburgh PA Breast Ca, past ASCO pres 

3. 

10 IM INTERNAL MEDICINE PM-ONC ALFRED MCKEE MD Asst Professor Tuf1 

10 PMM PAIN MEDICINE PM ALFRED ANDERSON MD Medical Director Me, 

Coa 

9 PMM PAIN MEDICINE PM JOHN HUNT MD Me, 

4. Infectious Disease Oral Solution Practice Steering Committee (to recruit from) - shoot for 10-15 

10 IM INTERNAL MEDICINE ID JOSEPH JEMSEK MD 

10 ID INFECTIOUS DISEASES ID ARDIS MOE MD 

10 ID INFECTIOUS DISEASES ID JOHN FANGMAN MD 

10 IM INTERNAL MEDICINE ID DAVID PARKS MD 

10 IM INTERNAL MEDICINE ID DONNA SWEET MD Kansas Univers 

10 IM INTERNAL MEDICINE ID NEIL FLYNN MD 

10 ID INFECTIOUS DISEASES ID RICHARD POLLARD MD 

10 ID INFECTIOUS DISEASES ID JOSEPH GATHE MD 

10 IM INTERNAL MEDICINE ID DAVID PRELUTSKY MD Southhamptorr 

10 ID INFECTIOUS DISEASES ID EDWIN DE JESUS MD Medical Director Orlando lmmur 

Confidential I NS-BOS-00989675 

Crystal Skelton - Denver, CO 

BENNETT, DANIEL, CO 

CLEMENS, ORRIE, CO 

HALL, TIMOTHY, CO 

JONES, BYRON, CO 

KESTEN, JEFFREY, CO 

KOONS, DEXTER, CO 

SHEMESH, GARETH, CO 

THORN, TERRI, CO 

WILENSKY, BONNIE, CO 

WRIGHT, STEVEN, CO 

Bill Winter - Kansas City, KS 

GOLD, KURT, NE 

GUARINO, ANTHONY, MO 

HALLEY, RANDALL, MO 

LANGE, MICHAEL, KS 

ROSE, JESSICA, NE 

SIMON, STEVEN, KS 

Tara Sunseri - Salt Lake City, UT 

BEDELL, RAYMOND, UT 

MILLER, GREG, UT 

SAXTON, PAUL, UT 

STIRLING, TODD, UT 

WAL KER, MARY, UT 

Ty Rustin - San Antonio, TX 

Confidential 

AVILA, FERNANDO, TX 

BACON, DONALD, TX 

BOYLE, DANIEL, TX 

BUYANOV, DMITRIY, TX 

GABRIEL, JOSEPH, TX 

HERNANDEZ, ARTHUR, TX 

JONES, STEPHANIE, TX 

SOMERVILLE, JUDSON, TX 

I NS-BOS-00990857 
Email Message 

From: Stacy Ruggiero 

Sent: Tuesday, March 13, 2012 6:01 PM 

To: Michael Babich 

Subject: FW: Upcoming Meetings 

FYI. .......... . 

From: 

Sent: Tuesday, March 13, 2012 11:00 AM 

To: Stacy Ruggiero 

Subject: RE: Upcoming Meetings 

Hi Stacy, 

I am sorry that none of these days will work for Dr. Von Hoff. 

Both of the Saturdays he is out of town for previously scheduled work commitments and the April date conflicts with his patient care at our clinic and since his main 

Nurse is on leave he feels he cannot also be away. 

My apologies for not being able to accommodate. 

Best, 

Tina 

From: Stacy Ruggiero 

Sent: Monday, March 12, 2012 12:25 PM 

To: Tina Harter 

Subject: Upcoming Meetings 

Good Morning Tina, 

Hope all is well! © 

Our "In-Person Consultant Meetings" will be held at the JW Marriott Camel back. (Dates highlighted below) Most of the doctors/attendees are listed below, but can 

always change until the actual event happens. Mike would like Dan to attend one/both any time between 8am - 4pm if his schedule permits ..... can you let me know 

if he'll be available? 

There is also an upcoming FDA meeting in Washington DC on April 17th Mike would like to know if Dan could attend with him? (Leaving PHX April 16th for the April 

17th meeting) 

Please let me know if you have any questions. 

Regards, Stacy 

Confidential I NS-BOS-00990862 
3/31/12 David Rosenfeld 

3/31/12 Benny Sanchez 

3/31/12 Gareth Shemesh 

3/31/12 Joseph Shurman 

3/31/12 Steven Simon 

3/31/12 Raymond Sorensen 

3/31/12 Lisa Stearns 

3/31/12 Sarah Turnipseed 

3/31/12 Robert Venuti 

3/31/12 Jose Villarreal 

3/31/12 Daniel Wik 

3/31/12 Bonnie WIiensky 

Stacy Ruggiero 

Executive Assistant/Office Manager 

State of Arizona Notary Public 

iinSYS 

MD 

MD 

MD 

MD 

MD 

DO 

MD 

NP 

DO 

MD 

MD 

MSN 

Confidential 

Physician Western Orthopaedics 

Scripps Hospitals/ 

Chairman of Pain Integrated Medical 

Management Research 

Assistant Clinical Kansas University 

Professor Medical Center 

Pain Institute of Tulsa 

Medical Director 

Medical Director 

Boulder Community 

Hospital 

Family Practice 

President Associates 

Pain and Spine Center 

Clinical Nurse Boulder Community 

Specialist Hospital 

3161 Howell Suite 

Mill Rd NW 310 Atlanta GA 30327 

2200 North Suite 

Loop West 102 Houston TX 77018 

1830 Franklin Suite 

Street 450 Denver co 80218 

9834 Genesee Suite 

Avenue 427 La Jolla CA 92037 

11120 

Tomahawk 

Creek Parkway Leawood KS 66211 

1145 South Suite 

Utica Avenue 364 Tulsa OK 74104 

4611 East 

Chea 

Boulevard Suite190 Phoenix AZ 85028 

311 Mapleton 

Ave Boulder co 80301 

188 Fries Mill Suite NRoad 3 Turnesville NJ 08012 

5652 North 

Mesa Street El Paso TX 79912 

1414 North 

13th Norfolk NE 68701 

311 Mapleton 

Avenue Boulder co 80304 

I NS-BOS-00990868 

Alec 

0250784009 A WERBUCH, GAVIN, Ml $ 

0481488175 SOMERVILLE, JUDSON, TX $ 

0540492030 CHUN, STEVEN, FL $ 

0100180116 ROSENBERG, JERROLD, RI $ 

6491477435 SPAGNOLETTI, LOUIS, NJ $ 

0300593025 GATZ, BART, FL $ 

0350889055 FANTO, STEVE, AZ $ 

8360181009 W AGHMARAE, ROMANTH, NY $ 

0384391068 KESTEN, JEFFREY, CO $ 

5500285012 FREEDMAN, GORDON, NY $ 

0000038973 GROTE, STEW ART, KS $ 

3050183031 SIMON, STEVEN, KS $ 

0384391048 GERBER, GREGORY, OH $ 

0410974108 SAJBEN, NANCY, CA $ 

7481067022 MAC, NELLY, CA $ 

8750288047 AKBIK, HAMMAM, OH $ 

5500281012 FINKELSTEIN, HARVEY, NY $ 

4220100034 MENKIN, SERGE, NY $ 

0110289009 BENNETT, DANIEL, CO $ 

0510484004 APRIL, MICHAEL, MD $ 

0164281059 MADISON, PAUL, IL $ 

0352076109 FYMAN, PHILLIP, NY $ 

0000034809 MATTHEWS, PHILIP, WA $ 

Confidential 

531,743 372 

706,489 210 

1,267,843 329 

475,336 160 

260,643 73 

286,021 130 

716,074 162 

418,369 11 2 

293,919 85 

438,081 11 0 

81,586 22 

138,254 49 

136,618 37 

119,422 15 

65,024 22 

192,679 23 

157,120 73 

111,152 25 

145,106 64 

221,793 50 

309,604 11 5 

188,513 58 

212,909 28 

351 

156 

94 

153 

44 

63 

76 

22 

32 

25 

15 

41 

23 

0 

9 

94 % $ 94&,JZ§ 

7 4 % $ "494,ggg 

29% $ 44$,0ZQ 

96% $ @$$19%8 

60% $ gJ&M·<$4 

48% $ gJJiS9P 

47% 

20% 

38% 

23% 

68% 

84% 

62% 

0% 

41% 

$ JZi,JSQ 

$ rn:~9[998 

$ 189l@'?Q 

$ Jg9Jgg§ 

$ ]Qt")~§§ ........................... 

$ JQ4r7'%4 

$ JQ4,QJ4 

Brett Szymanski 

Ty Rustin 

Daniel Tondre 

Abe Rosenberg 

Nanette Alonzo 

Mia Guzman 

Brianna Smith 

Katarina 

Haumesser 

Crystal Skelton 

Jonathan Roper 

Torgny Andersson 

Torgny Andersson 

Lisa McBride 

Colt Woods 

Brook Smets 

5 22% $ JQQ,Q19.$ Tracey Couch 

23 32% $ 9@[<$<$9 Sonia Palermo 

20 

37 

27 

89 

18 

22 

80% $ 9Q,§pg 

58% $ 9Q,&49 

54% $ $$,.$SQ 

77% $ &<$[@98 

31 % $ &@JqgQ 

79% 

Michelle 

Breitenbach 

Crystal Skelton 

Stephanie Torres 

April Moore 

Sonia Palermo 

Kristiana Wright 

I NS-BOS-00995591 
Email Message 

From: Alec Burlakoff

Sent: Tuesday, April 23, 2013 4:41 PM 

To: Sales All 

Subject: Top 25 Subsys and 'ROO' prescribers for the past 13 weeks 

Importance: High 

lnsys 

I realize you get this report, but I wanted to make sure you took notice of the column I highlighted in ygllpyi,. 

These are our top performing customers, there are the clinicians that make us 'tick'. 

Although I know it is imperative to continuously create new prescribers for Subsys, I am still positive that the greatest opportunity for bonus 

dollars remain with the 'big' doctors whom are already sold on Subsys. 

In the majority of cases 'not all', you will notice that the top 25 Subsys prescribers still only give us a smidgeon of their ROO business. 

This of course means GREAT opportunity for growth! 

Please proceed accordingly ............ . 

Dr. Steve Fanto is a perfect example of what I am referring to. 

This is NOT a negative in any way, conversely- it is just the opposite. 

Dr. Fanto is the 3rd largest ROO prescriber in the country, yet we are not even getting 1/3 of his ROO business. 

0350889055 FANTO, STEVE, AZ $ 716,074 

This is 1 of several stellar opportunities to grow the business quickly, again - this is just 1 example of a huge opportunity that many of us can 

identify with our top Subsys prescibers in our respective territories. 

Please proceed accordingly ............ . 

Thank You 

Confidential I NS-BOS-01004973 
Haumesser 

XMHOl 79514 HODGES, ERNEST, NC $ 147,416 53 10 19% Carrie Dove 

9134281002 MARKIV, VOLODIMIR, IL $ 156,221 41 14 34% VACANT 

0411477034 HOLZER, DONALD, VA $ 66,526 13 0 0% Carrie Dove 

0330592202 PITERA, MATTHEW, NJ $ 46,366 15 0 0% Francis Rizzo 

Andrew 

0000072504 JADALI, MICHAEL, CA $ 15,278 1 1 10 91% McNaughton 

6491488067 LEPORE, HENRY, NC $ 146,860 38 6 16% Carrie Dove 

4962493023 LAKKARAJU, RAVI, Ml $ 159,469 36 9 25% Brett Szymanski 

XMJ2075895 JONES, BRITTANY, AZ $ 108,864 31 5 16% Brianna Smith 

0051295228 PANG, NORMAN, CA $ 58,620 20 10 50% Gigi Brannon 

6493085018 MORALES, OSMIN, FL $ 77,966 57 16 28% Lilian Logatti 

0160190074 NATH, HEATHER, IN $ 140,326 51 28 55% Matthew Hughes 

9136482001 ARBUCK, DMITRY, IN $ 171,894 26 10 38% Matthew Hughes 

XMA2384395 ALFONSO, HEATHER, CT $ 290,444 11 3 24 21% Abe Rosenberg 

Andrew 

0000060452 ANDERSON, WAYNE, CA $ 131,828 42 28 67% McNaughton 

Katarina 

XMG2009769 GLASS, KA TH LEEN, NY $ 26,551 5 0 0% Haumesser 

Michelle 

0240777020 COHN, JOSEPH, NJ $ 146,227 51 0 0% Breitenbach 

0164303023 ANNELLO, PATRICK, NY $ 31,808 14 10 71% Sonia Palermo 

7370159028 PACHAS, WILLIAM, MA $ 102,130 56 19 34% Natalie Levine 

0160688119 SMITH, DAVID, CA $ 91,492 15 0 0% Colt Woods 

CodiAnne 

XMW0558099 WAL KER, MARY, UT $ 325,767 133 7 5% Christensen 

0000036923 WHALEN, THOMAS, PA $ 142,524 28 5 18% Ryan Mitchell 

0400288014 CHIU, ANDREW, OR $ 23,959 14 7 50% Jaimi Hooker 

0000144576 SAY ANLAR, JENNIFER, NJ $ 62,788 15 3 20% Sandy Wong 

0070299116 GROVE, JEROME, AZ $ 105,784 30 10 33% Brianna Smith 

XML0563468 LEONARD-BURNS, SOPHIA, MD $ 269,223 40 2 5% Jessica Larichiuta 

Confidential I NS-BOS-01004979 
Confidential 

Email Message 

From: 

Sent: 

To: 

CC: 

Subject: 

Importance: 

Sales 

Alec Burlakoff 

Wednesday, May 08, 2013 9:10:32 PM 

Sales All 

Michael Babich 

what is it going to take? 

High 

Please see the below report, I have sorted it from the largest 'ROO' prescriber down to 

the smallest. 

I look at some of these names, and I just can't believe that we do not get at least 50 

percent of their ROO business. 

I know the business model we have in place allows each and every one of you to 

devote more time, resources, and effort into each individual customer than any of our 

competitors. 

I know this, because I am the one who put this process in place. 

Either one of two things is happening and I will not stop until I find out. 

1. You are NOT following the company's direction and making it your 1 and only 

priority to OWN a customer 

OR 

2. You are not having success, tell me why? 

Please take a look at the percentages that I have begun to highlight. 

We give our blood, heart, and souls to these customers, and we can't even get half the 

business that I know we have in fact EARNED? 

I NS-BOS-01005027 
Confidential 

Some say, "Alec, there is not enough 'ROO' business' out there", the below reports 

indicates otherwise. 

THERE IS A TON OF BUSINESS .......... . 

I want to know 

why 

what is it going to take 

what are we NOT doing 

what more should we be doing 

I WANT THE BUSINESS THAT WE HAVE EARNED! 

I WANT ANSWERS, BECAUSE WE ARE ENTITLED TO HAVE THEM! 

Please send all communications to your managers, your managers will communicate 

their findings with me. 

One way or the other, this will not continue ( that I promise!) 

the below is an enormous slap in the face that none of us deserve .... 

WK Unique ID 

I NS-BOS-01005028 

Confidential 

Two Exceeding the Bare Bones Minimum of 2.5 per week: 

Nanette with 4 and Abe with 3. 

Why are they successful? First, if you haven't reached out (and I know you have), do so again. 

Their success is about "Swagger". Confidence and Commitment. And NOT letting the customer off of 

the hook. 

This is not about a "hopefully I'll get him" sell. It's about, "I'm getting him". Period. When Sonia calls 

me to tell me how p-d off she is about a doctor, she doesn't just tell me, SHE TELLS HIM. 

Michelle doesn't care how busy doctor Sun is. (She wanted to follow him to Hawaii, but didn't want to 

leave Menkin and Kauffman to think they were getting a break).She doesn't care about Dr. Menkin's 

"excuse jar". She doesn't care about Dr. Patharkar's push back. Michelle wants the script. Goal number 

1. 

Heck, Sue went back to Dr. Zhang and pulled one out of her this week. 

Abe is on the phone constantly with Heather Alfonso. 

Sonia runs with Dr.Litman. And almost lives in Lindencare. 

Somehow, Spags and Wolfe kept writing while Nanette was out. Wonder how that happened????? 

Roughly 40 selling days to get to 13%. As a region we need reach a weekly goal of 56 Trx to contribute 

to the goal and not ride on somebody's coat tails. 

Alec shared a formula that he's used, that I've used, and that Michelle/Sonia/Nanette use and are 

successful. It is not just about focusing on key targets, it's about selling those targets. It's about 

deciding that the primary goal is getting the script and taking every step to get and keep that 

prescription. Right now it's about execution. 

We'll talk later!! 

Frank 

Frank R Serra 

Northeast Regional Sales Manager 

iNSYS Therapeutics, Inc. 

I NS-BOS-01009356 

Confidential 

Good morning Managers 

"holidays dude", this is what I continue to hear ............... . 

This is absolute nonsense. 

It's nonsense, because we spent the past 6 months preparing for the holidays! 

What do I mean by preparing for the holidays? 

I mean that if we were truly getting the sales representatives to follow the direction down 

from the top, we would be able to sustain the 'hit' from the holidays. 

Holidays never hurt the representatives whom OWN five doctors. 

NEVER does there present a time where a sales representative can't generate 1 rx a 

day, because never is there a time where at least 1 of these 5 doctors are on vacation 

all at once. 

In fact, even if all doctors are out of the office at one time ( a good rep - will make sure 

'somehow I some way - a Subsys rx is written! ) 

I don't want to hear excuses, I want to see each rep generate 1 prescription per day. 

I understand I have been talking units, strength, market share, and net sales. 

The top performing reps should be having these 'higher' level conversations with you on 

a daily basis. 

This type of 'higher level' thinking will absolutely take these representatives to the next 

level, and ultimately result in what they really want. ( big bonus dollars) 

The problem is NOT the top representatives at lnsys, although we can and should 

always strive to make them better and adhere to the needs they have expressed along 

these lines. 

I NS-BOS-01009498 



Confidential 

Email Message 

From: Alec Burlakoff

Sent: Wednesday, December 19, 2012 2:56 PM 

To: Frank Serra 

CC: Michael Babich 

Subject: RE: Transition Game 

Good morning 

Great message Frank, thanks for your enthusiasm and efforts to make this happen! 

From: Frank Serra 

Sent: Wednesday, December 19, 2012 6:27 AM 

To: Abe Rosenberg; Jeff Pearlman; Katarina Haumesser; Michelle Breitenbach; Nanette Alonzo; Rebecca 

Haas; Ryan Mitchell; Sonia Palermo; Susan Seisler 

Cc: Alec Burlakoff 

Subject: Transition Game 

Team, 

While meeting with one of Katie's top docs, we had what was probably the 34]1h discussion on the 

Switch Program. 

Yet, what was the deal? Why was this guy who claims to love Subsys and love Katie leaving her on the 

curb? Quite honestly it always bugs the heck out of me when a doctor says how much he loves you, but 

doesn't care if you can feed your family or put gas in your car or buy shoes for the kids. If he loved you, 

he's be writing. 

Sorry for the side bar ...... and now ... back to the original message .. . 

So, here begins discussion 348 on the Switch program. 

Key points for Katie Discussion: 

• Clinically, doctor, why and how could you even consider OTFC over Subsys? 

o Katie had "Swagger" on this call. 

• lnsys is standing behind every switch patient 

o To which point he asked, "Why would you do that?" 

• He then shared with Katie, "My only concern is in transitioning patients from OTFC or Fentora". 

o OMG!!! lsthatAII????? 

o She did a great job letting him that not all patients are ready. However, if you don't ask 

you'll never know. She identified some patient types and gained his buy in that he has 

folks who would benefit. 

o Hey Doc, can I tell you about our switch program? (Seriously, Katie Re-launched the 

Switch program which she just discussed with him 10 minutes before) 

o However, NOW it made sense to him. "Transition" 

• Doc then asks," lnsys will help me with the Transition?" 

o Katie gave her commitment and lnsys commitment 

• My point is, identify the doctors hot button. We all know these guys are scared to death to talk 

to their patients about Switching. 

I NS-BOS-01014623 
Confidential 

Email Message 

From: 

Sent: 

To: 

CC: 

Subject: 

Abe, 

Michael Babich 

Wednesday, August 01, 2012 6:54:44 PM 

Abe Rosenberg 

Frank Serra 

CT 

Hope all is well and good to see some scripts coming out of the region! 

As you know, it is in all of our best interest to keep the focus on where the scripts are. I 

know the entering a top 20 was cumbersome (please no longer do) so we came up with 

something easier for me to be involved where the action is. I have listed your top 

targets below and need a brief weekly email summarizing how, if and when the doctor 

will write, if he is already and can he be a bigger doctor to you. 

In addition, I would like to know if calling on the following at least once per week is 

doable and why not. This exercise only needs to be done one and not weekly 

obviously. 

Here are some examples of how simple this is and what I am looking for followed by the 

doctors who I need weekly updates on. 

"He won't see me, only loves actiq and it's a waste of my time" 

"Been a huge supoorter of Subsys and I don't see it changing. I see him twice a week" 

"Great call this week, I think he is close to writing" 

"due to the long drive, I see him once every two weeks" 

INS-BOS-01017784 
Confidential 

I thank you for doing this and please start doing this once the week is done and by 

Monday am at the latest every week for me. 

ALFONSO,HEATHER,CT 

COONEY, ELIZABETH, CT 

MCGEENEY, BRIAN, MA 

ROSENBERG, JERROLD, RI 

ROSS,EDGAR,MA 

Michael Babich 

President and CEO 

INS-BOS-01017785 
Confidential 

Email Message 

From: 

Sent: 

To: 

BCC: 

Subject: 

Frank 

Alec Burlakoff 

Friday, November 09, 2012 11 :23:27 PM 

Frank Serra 

Michael Babich 

Abe Rosenberg 

Why has Abe not used this trained speaker to present via an ISP 

Comments 

Total ISP Speaker Usage (completed & Scheduled ISPs) 

RSM Region 

Territory 

Rep 

Speaker 

Classification 

Scripts 

Units 

WKID 

FULL NAME 

Degree 

Title 

Practice Name 

Address 1 

Address 2 

City 

I NS-BOS-01019987 


Confidential 

Email Message 

From: 

Sent: 

To: 

Subject: 

Attachments: 

Good e-mail! 

Alec Burlakoff 

Friday, November 16, 2012 9:48:16 PM 

Michael Babich; Frank Serra 

FW: Lets discuss 

Strength Makes the Difference.pptx 

From: Frank Serra 

Sent: Friday, November 16, 2012 2:47 PM 

To: Abe Rosenberg; Jeff Pearlman; Katarina Haumesser; Michelle Breitenbach; 

Nanette Alonzo; Rebecca Haas; Ryan Mitchell; Sonia Palermo; Susan Seisler 

Cc: Alec Burlakoff 

Subject: FW: Lets discuss 

Team, 

As Alec shared the value in 120 units per script, look at the attached spreadsheet that 

shows an approximate cash you'll make when making sure to have the effective dose 

conversation with each target. 

Note, that at 120 units, there is serious money to be made. 

And note that simply by taking each script to the Pl approved 4x's a day for a month, 

you can increase your payout on EXISTING patients. 

Every time a doc tells you they prescribed, the very next question should be, "How 

Many Units? And What Dose?". Bang and the door is wide open. 

Remember effective dose on every call with every customer. 

Thanks, 

Frank 

Frank R Serra 

Northeast Regional Sales Manager 

I NS-BOS-01021271 
Confidential 

Email Message 

From: Frank Serra 

Sent: Wednesday, October 17, 2012 9:43 PM 

To: Larry Dillaha; Matthew Napoletano 

CC: Alec Burlakoff; Teresa Grasso 

Subject: 4 NE Candidates for speaker training 

Hi Dr. Larry/Matt, 

I have three doctors and one nurse practioner who have been approved by Alec/Matt to be added to 

the speakers bureau. 

Dr. Pathakar, Dr. Kasendorf, and Heather should be able to join tomorrow. I haven't heard back from 

anyone they couldn't. 

Dr. Levy originally claimed next week would be easier, Becky is searching out now. Maybe 

communication from you could change his mind. 

If there is anything you need from me, let me know. 

Michelle Breitenbach: 

Dr. Pathakar: 

Sonia Palermo: 

Dr. Roger Kasendorf: 

Becky Haas: 

Dr. Eric Levy 

Abe Rosenberg: 

Heather Alfonso 

Thanks, 

Frank 

Frank R Serra 

Northeast Regional Sales Manager 

iNSYS Therapeutics, Inc. 

INS-BOS-01022111 
Confidential 

Email Message 

From: Frank Serra 

Sent: Tuesday, October 02, 2012 11 :30 AM 

To: Abe Rosenberg; Jeff Pearlman; Katarina Sullivan; Michelle Breitenbach; Nanette Alonzo; 

Rebecca Haas; Ryan Mitchell; Sonia Palermo; Susan Beisler 

CC: Alec Burlakoff 

Subject: "l" a Day Vitamin 

Attachments: Northeast - 1 RX day 10.1.12.xlsx; NE Go To.xlsx 

Team, 

I wanted to let you know your efforts getting out of the gates to generate 1 Trx per day are apparent. 

This is where the work begins. Follow UP, Follow UP, Follow UP. 

In sales, nothing changes unless WE change. The doctors will do the same dance over and over, they'll 

even let us lead, as long as we keep doing the same thing again and again. 

While, quite honestly, each of you has a multitude of customers who are "On the edge of the High Dive", 

we need to change the structure of how we approach the business. 

Docs who are listening to you want to prescribe, they simply don't know how. That's why we're 

here. Show them. By showing them, you eliminate the barriers to the prescription. 

Identifying the Key Go To customers keeps your eyes on the end zone. 

Changing the structure of the call with these (and the 1200/1600 docs), keeps you in control of the 

conversation. 

If you remember from launch, we talked at length that in this market each script must be handheld. 

By holding the customer to the "1 patient" coming in today, you eliminate the distraction of having to 

remember somebody who is coming in. 

By hold the customer accountable to which patient they will prescribe for, keeps THEM focused. 

By letting them know you're standing right by them watching, keeps them committed. 

By following up with the doctor within the next day or 2, shows YOUR commitment. 

You now have what I call a "Shorter Call Universe". It's an awesome responsibility. No dead weight to 

deal with. 

Please review the notes on the Co-Pay/Voucher. If you have any questions, please do not hesitate to 

call. 

I'll be chatting with everyone,please do not hesitate to call me with any questions. 

Thanks, 

Frank 

Frank R Serra 

Northeast Regional Sales Manager 

iNSYS Therapeutics, Inc. 

I NS-BOS-01027 431 
Confidential 

Email Message 

From: Alec Burlakoff

Sent: Tuesday, October 02, 2012 12:53 PM 

To: Frank Serra 

Subject: Re: 11 l II a Day Vitamin 

Hi Frank 

Great e-mail, we are most definitely on the same page ... 

Alec 

Sent via BlackBerry by AT&T 

From: Frank Serra 

Date: Tue, 2 Oct 2012 04:29:47 -0700 

To: Abe Rosenberg ; Jeff Pearlman

Katarina Sullivan Michelle 

Breitenbach< Nanette Alonzo Rebecca 

Haas Ryan Mitchell Sonia 

Palermo< Susan Beisler

Cc: Alec Burlakoff

Subject: 11 l II a Day Vitamin 

Team, 

I wanted to let you know your efforts getting out of the gates to generate 1 Trx per day are apparent. 

This is where the work begins. Follow UP, Follow UP, Follow UP. 

In sales, nothing changes unless WE change. The doctors will do the same dance over and over, they+II 

even let us lead, as long as we keep doing the same thing again and again. 

While, quite honestly, each of you has a multitude of customers who are +on the edge of the High 

Dive+, we need to change the structure of how we approach the business. 

Docs who are listening to you want to prescribe, they simply don+t know how. That+s why we+re 

here. Show them. By showing them, you eliminate the barriers to the prescription. 

Identifying the Key Go To customers keeps your eyes on the end zone. 

Changing the structure of the call with these (and the 1200/1600 docs), keeps you in control of the 

conversation. 

If you remember from launch, we talked at length that in this market each script must be handheld. 

By holding the customer to the +1 patient+ coming in today, you eliminate the distraction of having to 

remember somebody who is coming in. 

By hold the customer accountable to which patient they will prescribe for, keeps THEM focused. 

By letting them know you+re standing right by them watching, keeps them committed. 

By following up with the doctor within the next day or 2, shows YOUR commitment. 

I NS-BOS-01027 440 
Confidential 

Email Message 

From: Frank Serra 

Sent: Wednesday, October 03, 2012 12:30 PM 

To: Abe Rosenberg; Jeff Pearlman; Katarina Sullivan; Michelle Breitenbach; Nanette Alonzo; 

Rebecca Haas; Ryan Mitchell; Sonia Palermo; Susan Beisler 

CC: Alec Burlakoff 

Subject: I a Day 

Attachments: Northeast - I RX day 10.2.12.xlsx 

Team, 

Your efforts, again, are focused on the right customer. There isn't one doc on this list that you haven't 

established a solid relationship with. Therein lies the magic of the "Go To" doctor. 

Also to note, your notes to me when sending the spreadsheet are chock full of the activity you have in 

the customers office, in fact, not only are you working for today's script, but you've also communicate 

the docs whose patients are coming in on Thursday or Friday. Awesome opportunity to find ANOTHER 

reason to go back to that office. (If too far, give them a call.) 

Some Bullets: 

• Fingertip Formulary appears to have made a splash!! It's a great tool to use to address 

situations right there. Solve the problem IMM ED IA TEL Y! ! 

• Focusing in on the docs who are the 1200/1600 Actiq's. In fact, Sue shared with me a situation 

where one of her advocates placed HIGH on the list, so when she looked up the data, she noted 

he hadn't written as much Subsys as he told her!! Needless to say, Sue was right there in his 

face. Talk about accountability. 

• Abe is spending quality time with his 9 decile target!! And making a hit in MA, spending more 

time in Mass than most of the politicians. 

• After pounding on Dr. Cole, Becky got him to crank out another. Believe me, he's a piece of 

work, but Beck isn't laying off. 

• Katie is on the 90 heading to the Eastern portion working over the phone with a practice 3 hours 

away 

• Michelle officially moved into Dr. Sun's house. Every time he turns around, she is there 

• Ryan hammered Dr. Padnes on what was his first official sales call. Called the office back and 

the staff assured him that Doc wrote Subsys!! Should track today. 

• Jeff and I will have lunch tomorrow with his number one target. He is all amped up to get out 

into the field. 

• Sonia has two phenomenal programs lined up. One has her TOP DOCS coming and the other has 

all of the Pain NP's in Long Island attending. 

My point is that all of these actions are those that PRODUCE results. The saying goes that you have to 

earn the right to close. That's BULL. You have not only have earned the right to close, but you've 

earned the business. Take it!! 

Looking forward to spectacular results. Keep up your efforts. Keep up your passion. 

Take Care, 

Frank 

I NS-BOS-01027 444 
Performance Improvement Plan 

To: Abe Rosenberg, Specialty Sales Professional 

From: Frank Serra, Regional Sales Manager- Northeast 

Subject: Performance Improvement Plan (PIP) 

The purpose of this memorandum is to afford you a formal, structured opportunity to demonstrate 

acceptable performance in all the critical elements of your position. This memorandum confirms our 

discussion of 11/2/12, during which I informed you that you are failing to meet the standard for certain 

critical results of your position. 

Because your current performance is unacceptable, you will now be provided a formal opportunity to 

demonstrate that you can perform at the "Meets Expectations" level with respect to the critical results and 

performance indicators, listed below. This formal opportunity period will begin on 11/2/12 and end on 

01/31/13. If at the end of this period your performance has not improved to the "Meets Expectations" 

level, or if your performance does improve to the "Meets Expectations" level but you do not sustain that 

level for at least one year, then you may be placed on another PIP or a recommendation may be made to 

terminate your employment. 

The critical result(s) and performance indicator(s) that you are failing and examples of your unacceptable 

performance follow: 

• Average of 2.0 Trx per week. The Company goal is to achieve at least an average of 2.5 Trx 

per week. 

CRITICAL RESULT 1 (Promoting INSYS' Products) - Develop a customized approach for each call 

on each customer to access customer needs and increase sales of INSYS products. Read and react to 

customer environment. Employee's sales outcomes and activities consistently reflect a full and up-to-date 

command of the methods, approaches, techniques, and technologies involved in impacting pharmaceutical 

sales. Employee also displays a working knowledge of the concepts, resources, processes, and policies 

associated with pharmaceutical sales. Employee demonstrates consistent factual reliability and good 

technical judgment. 

You are failing to meet the Meets Expectations level in this critical result of your position. 

1. Example 1 - Generate Prescription Volume/Increase from the following Key Customers: 

EDGAR ROSS 9 0 4542 

HEATHER .......................... 

ALFONSO 9 120 6330 ... : .:::::. :< :\.: ::::. : /::.<. 

BRIAN MCGEENEY 8 0 3222 

DAVID MONTI 7 0 2820 

FATHALLA MASHALi 7 0 2238 

1 

Confidential I NS-BOS-01028253 
MICHAEL ROSSEN 6 0 1344 

MARILOU OH 6 0 1496 

MARK THIMINEUR .... :::.::.::i:::.::.::/::.::::_:::::.:.::: 6 0 1098 

WILLIAM BACHAS 5 60 860 

MICHAEL ROBBINS 5 0 886 

EDISON WONG 5 0 892 

JAMES BRODEY 5 0 1020 

LUCILLE LANNA 5 0 900 

MICHAEL MARCIELLO 5 0 1080 

DANIEL FELDMAN 5 0 930 

JONATHAN KOST 4 0 676 

MARY ONEAL 4 0 784 

JERROLD ROSENBERG 4 450 982 ................................. 

CAROLINE COLOZZI 4 0 720 

EDWARD MICHNA 4 0 830 

Physicians Highlighted in Yellow, you've already made impact with. Continue to drive your efforts to 

these customers. 

CRITICAL RESULT 2 - (Speaker Programs) - Effectively utilize all available resources to sell and 

promote INSYS products, including determining which resources to use in any given situation. 

You are failing to meet the Meets Expectations level in this critical result of your position. 

1. You've also signed Heather Alfonso to speak on behalf of Insys and are currently working to 

build programs for her, since her completion of training two weeks prior. You've also made 

strides getting Dr. Rosenberg out to speak at both lunches/dinners. 

Confidential 

2. Prior to November 23rd' have at least 4-5 programs executed for Heather Alfonso. 

3. Prior to November 23rd' have at least 4-5 programs executed for Dr. Rosenberg 

a. You've already committed to programs with Wong and Shifreen who are two Actiq 

Switch Targets. 

4. Continue your efforts with Michna/Ross in Boston. 

CRITICAL RESULT 3- (Effectively manage and prioritize time and available resources to achieve 

maximum sales in the local territory) - Effectively manage and prioritize time to ensure maximum 

customer penetration and sales volume with limited supervision. Evaluate, identify, and develop order of 

calls and routes that maximize the opportunity to call on targeted customers. 

2 

I NS-BOS-01028254 
Email Message 

From: Frank Serra 

Sent: Saturday, November 10, 2012 4:45 PM 

To: Alec Burlakoff 

Subject: Re: Abe Rosenberg 

Damn Right. I know she was all fired up to get trained on the last training session. 

She definitely wants to speak, abe's been in there working to get her dates and places lined up. 

she got whacked by the storm so that put things back. 

That's why I told him to plan it, TELL her when and where. And done. It's not rocket science. 

No excuses at all but he needs to finish this off. 

Now go enjoy spongebob square pants with the kids!!! 

Thanks 

Frank 

Sent from my iPad 

On Nov 10, 2012, at 11:30 AM, "Alec Burlakoff" wrote: 

Frank 

This clinician is writing, she has experience ... 

She needs to speak ASAP 

Alec Burlakoff 

Vice President, Sales 

INSYS Therapeutics, Inc. 

On Nov 10, 2012, at 6:43 AM, "Frank Serra" wrote: 

I'll also tell him 1 a week till years end. 

He communicates with her all the time, which means there is no reason. 

Sorry for incomplete sentences. 

Thanks 

Frank 

Sent from my iPhone 

Confidential I NS-BOS-01028310 
Confidential 

See how your payout will differ for ONE paid script, 120 

units, under each strength 

JOOMCG 200MCG 400MCG 600MCG 300MCG 1200MCG 1600MCG 

NOTE: * 10°/o Bonus payout for 1 OOMCG-SOOMCG paid scripts 

** 12.5°/o Bonus payout for 1200MCG-1600MCG paid scripts 

For internal planning purposes only I 

I NS-BOS-01028895 

Confidential 

Why? Fentora and Actiq patients do not want to make the switch and Mr. Chatman 

does not push for it. Mr. Chatman does not want to deal with the paperwork even 

though I have assured him and proved to him that I can do everything except write the 

RX. I have went as far to complete opt in forms with pt names on them and he said 

"you have done enough at this time" I am in the office 3 days a week and have solid 

relationships with everyone in the office including Dr. Hymes who is a speaker for 

Subsys and who Mr. Chatman is employed under. 

What's it going to take? I visit Mr. Chatman 2x a month Saturday evenings with my 

girls at his night clinic. I can tell you everything about his family and personal life. I 

have invited him to dinner but he is not interested as he is over committed with work. 

will continue to ask for business. 

What am I not doing? Writing the RX and challenging the patients to switch. I am not 

signing the opt in form. I challenge and ask for business every time I see Mr. 

Chatman. There is a fine line with him though and I know when to push and went to 

back away. 

What more should I be doing? Challenging Hymes to have a talk with Chatman. 

Sara Sadraie 

Specialty Sales Professional 

lnsys Therapeutics 

On May 8, 2013, at 5:26 PM, "Darin Fila" wrote: 

I NS-BOS-01031468 

Confidential 

negotiated a discount on Fentora after their recent price hike. We will be looking to 

doing the same with Medco and are evaluating if we will need to. We received this 

updated info Friday on a call with Medco and will keep the sales team updated once 

we know more. Long and short of it, Medco covers Subsys and Fentora. Contact 

Jim, your rsm or myself with any questions. 

- New contest! Note this contest is for July and August combined. 3 out 4 patients 

on in the clinical trial titrated to 600 mcg or higher. The top 5 ssp's who have the 

highest number of UNITS written for 600 mcg or higher will receive an extra $1500 

and the overall winner will get $2000. 

- New July contest. This one will end at the end of July. We are able to track 

market share in each territory. Therefore, we will calculate subsys market share for 

July in each territory and the top 5 market share territories for the month of July only 

will receive 500 additional stock options and $1,000. 

- Finally, your Rsms, marketing and clinical all just put on whole hell of a show this 

weekend in Chicago. Thank you to them and to the sales force as we hit our goal of 

75 doctors live. It was a tremendous learning session and I received so many 

compliments about our sales force. This is our biggest opportunity to continue to 

take share from Actiq and fentora. Matt may sleep until Wednesday and that is ok 

cause he drove this program so well and we need to capitalize on these doctors this 

week and for years to come. 

Have a great week and please contact me if I can be of any assistance. 

My best, 

Mike 

Sent from my iPad 

I NS-BOS-01058063 
Confidential 

Email Message 

From: 

Sent: 

To: 

CC: 

BCC: 

Subject: 

Abe Rosenberg 

Wednesday, August 01, 2012 10:30:20 PM 

Michael Babich 

Frank Serra 

RE:CT 

Hi Mike, my responses are below. 

ALFONSO, HEATHER, CT: is writing, likes subsys and says she wants to switch all 

patients off of Actiq to Subsys! I visit her at least once a week and sometimes twice. 

COONEY, ELIZABETH, CT: Has moved out of my territory into Waterbury CT as far as 

I know. 

ROSENBERG, JERROLD, RI: Been a huge suporter of Subsys and I dont see it 

changing. I see him twice a week 

MCGEENEY, BRIAN, MA: Does not see reps. at his new location but I am attempting to 

make contact elsewhere as he is a high decile. 

ROSS, EDGAR, MA: Have got some face time with other Dr. 's in his practice and am 

attempting to set up an educational meeting with him on Subsys. 

From: Michael Babich 

Sent: Wednesday, August 01, 2012 2:54 PM 

To: Abe Rosenberg 

Cc: Frank Serra 

Subject: CT 

Abe, 

Hope all is well and good to see some scripts coming out of the region! 

As you know, it is in all of our best interest to keep the focus on where the scripts are. I 

know the entering a top 20 was cumbersome (please no longer do) so we came up with 

I NS-BOS-01060255 
Confidential 

Email Message 

From: 

Sent: 

Frank Serra 

Wednesday, November 14, 2012 1:27 PM 

To: 

Cc: 

Abe Rosenberg; Jeff Pearlman; Katarina Haumesser; Michelle Breitenbach; 

Nanette Alonzo; Rebecca Haas; Ryan Mitchell; Sonia Palermo; Susan Beisler 

Alec Burlakoff 

Subject: FW: SUBSYS Top 50 Writers 11-09-2012.xlsx 

Attachments: SUBSYS Top 50 Writers 11-09-2012.xlsx; ATIOOOOl.htm 

Team, 

Take note of Alec's comment below, more specifically the comment, "What other meds is the patient 

on?" 

Katie had a solid example of an NP who shared she had a patient on 3 of the .25 patches plus Actiq 6x's a 

day@1200. 

Uhhh, clearly something is not working. Better yet, the patch and the Actiq were generic. As you know, 

if you've read the Hatch-Waxman Act, generics can vary up to+/- 20%. 

And on the upside, this is a practioner who is not afraid to titrate, you think? 

Its infinitely easier to get somebody who is Writing to Write MORE. We simply need to open the doors. 

That's why we're here. 

We'll talk later. 

Ciao 

Frank 

Frank R Serra 

Northeast Regional Sales Manager 

iNSYS Therapeutics, Inc. 

From: Alec Burlakoff 

Sent: Tuesday, November 13, 2012 2:48 PM 

To: Sales All 

Cc: Sales RSMs; Michael Babich; Matthew Napoletano 

Subject: : SUBSYS Top 50 Writers 11-09-2012.xlsx 

Hello lnsys 

Please see the attached, this is one of my favorite reports. 

Please LOOK to see if any of your doctors are on this list. 

I want you to take specific notice of the number of units per prescription your doctor is prescribing. If it 

is less than 60 per day, your message to this doctor should be built around increasing the number of 

units per day by just 1 unit. 

What other meds is the patient on? 

Can we increase Subsys units per the ( Pl ) to 120 units and remove one of the short acting opioids? 

I NS-BOS-01077246 
Confidential 

It is much easier to take an existing patient and double their units ( which in essence is the same as 

generating a new prescription ) 

The patient has already been through PA process, it is 'low hanging fruit'. 

Be smart and work smart, lets take the existing writers and create a habit of he or she using Subsys 4 

times a day ( as intended) as opposed to the prescriber 'sprinkling' a little Subsys on top of the patient's 

current medications. THIS IS THE NEXT BIG STEP! 

Please call me with questions ..... . 

Alec Burlakoff 

Vice President, Sales 

INSYS Therapeutics, Inc. 

Begin forwarded message: 

From: "Xun (Sean) Yu" 

Date: November 12, 2012 12:40:02 PM PST 

To: Alec Burlakoff 

Subject: SUBSVS Top 50 Writers 11-09-2012.xlsx 

I NS-BOS-0107724 7 

Confidential 

rationa'I behind it, your rational for not dropping everything in order to fine tune every 

single detail associated with each program opportunity bewilders me. 

I said it a thousand times. 

ISP's are the most important thing you will do to increase your business. 

IS P's are basically the ONLY thing you should be focusing on to increase your sales. 

ISP's are a ton of hard work to put together, that's why most reps do not do many 

programs. 

Most of you say you want to work, say you want to make money, but don't put forth the 

necessary effort pertaining to ISP's to back up what you say. 

What are you wasting your time on? 

Are you still making your 12 calls a day and moving zero business, while at the same 

time disrespecting yourself because your doctors see you as a 'UPS' salesperson as 

opposed to a business professional? 

If you are not living, eating, and breathing ISP's to drive sales, you should not be in 

specialty pharma. 

You need to work for "big pharma", and collect 20 signatures a day. 

I want lnsys to be seen and respected as business people, 20 calls a day in the 

hallway -will not make this happen! 

The top performers are working all day to schedule programs with every single detail 

'checked off', they are spending their evenings with their top prescribers while his or her 

speaker trains the clinician on how to prescribe Subsys. 

That's the formula! 

What the hec else is there to do in this industry? 

I NS-BOS-01081021 


Confidential 

Heather Alfonso, APRN 

• TRX Q1 to date: 19 

• Calls: 100 

• MEPS: 1 

• Hot buttons: Likes subsys "no street value" 

• Potential: Works in large pain practice certainly has more 

patients that could benefit from treatment with subsys 

• Goal: Use her to get other doctors in practice writing as well. 

• Challenge: Most patients on public health plans 

• Special note: Her and I have become friends she def. will keep 

writing and I will use our friendship to increase script count and get 

more writers in CT 

• Trending: Q1 washer highest script count thus far 

• Plan: Get her more ISP's and keep her happy and writing. Get her 

to use OPT In more. 

I NS-BOS-01083656 
Confidential 

Email Message 

From: 

Sent: 

To: 

BCC: 

Jeff Pearlman 

Wednesday, May 29, 2013 1 :10:58 AM 

Abe Rosenberg 

Subject: FW: IMPORTANT - Hartford, CT Daily REMS Report/ Authorized Rx Count -

5.23.13 

Importance: High 

Attachments: Authorized Rx Count 3.26.12 - 5.23.13 NYC-102 Hartford, CT.xlsx 

Abe, in looking to help you manage your territory both with new and existing physicians, 

I wanted to bring to your attention the prescribing pattern of Heather Alfonso, someone 

you have recommended as a speaker to influence others and educate them in the use 

of Subsys. In analyzing her numbers there are two things that stand out to me. 

1. It seems as it may be a struggle for her to identify new patients on a regular basis 

who will benefit from the use of Subsys. How many current patients does she have on 

Subsys? How many new patients in the last 30 days? 

2. With the exception of one recent script, every script is for 30 units. The average script 

trx runs in the 70-80 range and it is pretty standard for many of the patients to be using 

the drug up to 4 times per day, allowing for a 120 count script. She does not have a 

single patient on a 4x/day regimen. Why not? 

I am not sure what the issues at hand are here but I feel it is clear by these two 

indicators that she either has not been sold on the true benefits of using our product as 

the real break through pain remedy or she has some insecurities still which keep her 

from prescribing it at the "usual" 120 count. 

Given these facts is this really someone we can feel comfortable that they are 

representing our product well and are helping you to promote Subsys in the best light to 

other prescribers? 

I welcome your thoughts and insight. 

Jeff Pearlman 

Regional Sales Manager 

INSYS Therapeutics, Inc. 

From: Xun (Sean) Yu 

Sent: Friday, May 24, 2013 11:53 AM 

INS-BOS-01121885 
Confidential 

Email Message 

From: Abe Rosenberg 

Sent: Wednesday, June 05, 2013 10: 12 PM 

To: Jeff Pearlman 

Subject: RE: IMPORTANT - Hartford, CT Daily REMS Report/ Authorized Rx Count -

5.23.13 

I have been considering my response to this email very carefully and I have come to the conclusion that 

Heather is absolutely a great speaker on behalf of Subsys and our company moving forward. I have 

spoken with her about her script count and also her hesitancy to write 120 unit scripts. She has informed 

me that in her opinion it "safe practice" to first titrate slowly and then also to slowly increase the times 

per day. Both practices I personally support and also know Insys as the new branded leader in the 

ROO's market does as well. Heather has assured me she will continue to increase script units on a 

"individual patient" basis and need. A practice mandated by the REMS board. She is also constantly 

trying to identify new Subsys candidates and found one today. When you come to her ISP this month I 

am sure you will also see her passion for Subsys and these doubts will be put to rest. 

Best, 

Abe 

Abe Rosenberg 

Specialty Sales Professional 

Insys Therapeutics, Inc. 

From: Jeff Pearlman 

Sent: Tuesday, May 28, 2013 9:10 PM 

To: Abe Rosenberg 

Subject: FW: IMPORTANT - Hartford, CT Daily REMS Report/ Authorized Rx Count - 5.23.13 

Abe, in looking to help you manage your territory both with new and existing physicians, I wanted to bring 

to your attention the prescribing pattern of Heather Alfonso, someone you have recommended as a 

speaker to influence others and educate them in the use of Subsys. In analyzing her numbers there are 

two things that stand out to me. 

1. It seems as it may be a struggle for her to identify new patients on a regular basis who will benefit from 

the use of Subsys. How many current patients does she have on Subsys? How many new patients in the 

last 30 days? 

2. With the exception of one recent script, every script is for 30 units. The average script trx runs in the 

70-80 range and it is pretty standard for many of the patients to be using the drug up to 4 times per day, 

allowing for a 120 count script. She does not have a single patient on a 4x/day regimen. Why not? 

I am not sure what the issues at hand are here but I feel it is clear by these two indicators that she either 

INS-BOS-01127761 

Email Message 

From: 

Sent: 

To: 

Subject: 

Jeff Pearlman 

Wednesday, June 05, 2013 10:26 PM 

Abe Rosenberg 

RE: IMPORTANT - Hartford, CT Daily REMS Report/ Authorized Rx 

Count - 5.23.13 

I am not in a position to say what her patients should be getting as far as 30 or 120. She is the doctor, 

that is for her to say for her patients. What I am concerned about is you and I spoke about 6 weeks ago 

when we were giving her this extra program and asked if her finding 1 new patient a week was a 

reasonable expectation and something to be accountable to. You told me she said yes and that you 

would be able to hold her accountable to that. In looking at 1 new patient in April and just 1 in May it is 

clear that is not happening. 

Keep in mind these emails are for you and me, not her. But our conversation was very clear about what 

had to happen. I am not sure why from the tone of your reply you now are seeming to hedge off of that 

commitment? 

Very simply when I look at return on investment as she has not motivated any new prescribers as of yet 

and she is not significantly increasing her own business, I am going to have tremendous difficulty in 

justifying more programs. 

Confidential 

Am I not understanding some part of why she committed to one new patient per week and it is not 

happening? 

Jeff Pearlman 

Regional Sales Manager 

INSYS Therapeutics, Inc. 

Error! Filename not specified. 

From: Abe Rosenberg 

Sent: Wednesday, June 05, 2013 6: 12 PM 

To: Jeff Pearlman 

Subject: RE: IMPORTANT - Hartford, CT Daily REMS Report/ Authorized Rx Count - 5.23.13 

I have been considering my response to this email very carefully and I have come to the conclusion that 

Heather is absolutely a great speaker on behalf of Subsys and our company moving forward. I have 

spoken with her about her script count and also her hesitancy to write 120 unit scripts. She has informed 

me that in her opinion it "safe practice" to first titrate slowly and then also to slowly increase the times 

per day. Both practices I personally support and also know Insys as the new branded leader in the 

ROO's market does as well. Heather has assured me she will continue to increase script units on a 

"individual patient" basis and need. A practice mandated by the REMS board. She is also constantly 

trying to identify new Subsys candidates and found one today. When you come to her ISP this month I 

am sure you will also see her passion for Subsys and these doubts will be put to rest. 

Best, 

Abe 

INS-BOS-01127763 
Email Message 

From: Abe Rosenberg 

Sent: Wednesday, June 05, 2013 10:39 PM 

To: Jeff Pearlman 

Subject: RE: IMPORTANT - Hartford, CT Daily REMS Report/ Authorized Rx Count -

5.23.13 

I fully understand your concern and I hope it has only been an issue of finding the right candidates for 

Subsys. 

I will see her again on Friday and will continue to remind her of that verbal agreement. 

Abe Rosenberg 

Specialty Sales Professional 

Insys Therapeutics, Inc. 

From: Jeff Pearlman 

Sent: Wednesday, June 05, 2013 6:26 PM 

To: Abe Rosenberg 

Subject: RE: IMPORTANT - Hartford, CT Daily REMS Report/ Authorized Rx Count - 5.23.13 

I am not in a position to say what her patients should be getting as far as 30 or 120. She is the doctor, 

that is for her to say for her patients. What I am concerned about is you and I spoke about 6 weeks ago 

when we were giving her this extra program and asked if her finding 1 new patient a week was a 

reasonable expectation and something to be accountable to. You told me she said yes and that you 

would be able to hold her accountable to that. In looking at 1 new patient in April and just 1 in May it is 

clear that is not happening. 

Keep in mind these emails are for you and me, not her. But our conversation was very clear about what 

had to happen. I am not sure why from the tone of your reply you now are seeming to hedge off of that 

commitment? 

Very simply when I look at return on investment as she has not motivated any new prescribers as of yet 

and she is not significantly increasing her own business, I am going to have tremendous difficulty in 

justifying more programs. 

Confidential 

Am I not understanding some part of why she committed to one new patient per week and it is not 

happening? 

Jeff Pearlman 

Regional Sales Manager 

INSYS Therapeutics, Inc. 

INS-BOS-01127767 
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For internal planning purposes only 3 

Confidential INS-BOS-01179501 
Lf~t.~~.,·r.--iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiliilililiililiiiiiiiiiiiliiiiiiiiiiiiiiiiiiiiillllllllllllllllllllllllllll 

.·.·.·.······•····•· ··•······•••·· '.1·i·· ··· ... · ...·····•···•····· .... ·.·.· ... ······.·.· ... ·····.·.·.·.·.·.·.·.·.i·.·.·······.: ....... ·.·.· .. i .·.···1·· .... ·.· ... ·.· ... ·.·· .. ii.·.·.·.·. 

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:\: · JJJ: /{/: :_:::::::i \) /!: i: : : : ) :iii /\ /Jii: i :iii i iii /!: :r :_:::::::i \) /!: i\.·: :.: :_ /: /i. /Ji 

For internal planning purposes only 5 

Confidential INS-BOS-01179503 
Confidential 

Obviously, the clinicians will need to officially confirm with Desiree in the home 

office. 

Alec 

From: Matthew Napoletano 

Sent: Thursday, November 29, 2012 4:26 PM 

To: Desiree Hollandsworth 

Cc: Michael Babich; Alec Burlakoff 

Subject: 2013 Strategic Ad Board 

Here is the list of 59 invitees for the 2013 Strategic Planning Ad Board to be held in 

Scottsdale on 1 /19/12. I would anticipate a best case response rate of 70% which 

would be around 40-45 attendees. Please send a hold the date tomorrow in the am 

pending Mikes approval. 

NAME 

TERR# 

SSP 

REG 

DECILE 

SPAGNOLETTI, LOUIS, NJ 

101A09 

Nanette Alonzo 

101 

D10-8 

WAGHMARAE,ROMANTH,NY 

INS-BOS-01187260 
Confidential 

D7-5 

SIMON, STEVEN, KS 

104A05 

Torgny Andersson 

104 

D10-8 

BENNETT, DANIEL, CO 

104A04 

Crystal Skelton 

104 

D10-8 

TAYLOR,DONALD,GA 

103A01 

Marcus Seiferth 

103 

D10-8 

CHATMAN,GERALD,CA 

105A02 

Sara Sadraie 

105 

D10-8 

SAXTON, ERNESTINA, CA 

105A12 

INS-BOS-01187267 
Email Message 

From: 

Sent: 

To: 

BCC: 

Subject: 

Jeff Pearlman 

Tuesday, March 26, 2013 3:00:50 PM 

Sales Team - NYC 

presentation 

Thought this sample might help you with your presentations. Just be original and 

specific to your territory please as opposed to using these answers and taking the easy 

road. I do expect one of the bigwigs to sit in on these, just no idea which one. 

1. SWOT analysis 

a. 1. Identify Strengths; These strengths are the good things about your business unit 

i. 1. Great Access to Key Docs 

ii. 2 key pharmacys 

iii. Solid support from top decile docs 

b. Weakness: what are the area you need to strengthen 

i. 1. Need to increase the number of pharmacies who I can work with 

outside of Lindencare 

ii. Get somebody to write who isnt a speaker 

iii. % Net has increased 

C. Opportunities: 

i. Horizon Blue Tier Two 

ii. NY Medicaid reimburses for Subsys 

iii. New Pain Doc joining big practice 

iv. Fentora Rep just quit 

V. Key doc inconsistent 

d. Threats: 

i. Stop phoning it in, get into field before I get caught 

ii. Depending on Linden Care. 

iii. Lazanda hustling into my key accounts and Im someplace else 

iv. No ROI from speaker programs 

v. Fentora rep piggy backing my programs 

2. Business Analysis: 

a. Identify your Top 5 Targets 

b. Identify them as A Target, B Target, or C target 

c. What is the current situation? Are they Trending up or down or flat 

d. What is the expected outcome? 

e. What are you currently doing to change the outcome? 

3. For Example: 

a. Dr. Springsteen, number one target 

b. Dr. Springsteen is currently an A target 

i. He prescribes Subsys 3 times a week, Actiq 4 times a week, and Fentora 1 

time a week. 

ii. Trending flat for Subsys and Down for Actiq 

iii. My goal is to get the extra 4 Actiq scripts from him by May 1. 

iv. I am working to get Dr. Simon in front of him. Planning a lunch. 

Confidential I NS-BOS-01222132 
Email Message 

From: 

Sent: 

To: 

Cc: 

Subject: 

Good evening, 

Michael Babich 

Monday, June 25, 2012 2:22 AM 

Sales All 

Matthew Napoletano; Lindsay Couturier 

The home stretch of the quarter 

Tomorrow starts the final week of our first quarter promoting subsys. In this short time, we have all made 

tremendous strides in the field, grown as a team and have seen efforts pay off with patient satisfaction. It's easy to 

say things like many do such as "I am in sales", but you are all different and you are selling relief that changes 

patients lives. Giving relief faster, more powerful and in a convenient way is our simple message but you all have 

seen some of the patients you are affecting and you know it's so much more than that. 

The next two weeks are crucial for your personal success. Why? First, this final week has a lot at stake with the 

June contests and you can also beef up your bonus with some large unit numbers when it matters most. Second, the 

fourth of July falls on a strange day this year and many other reps will think everyone is off that week. Use this 

week to figure what days your high prescribers will be in during the fourth of July and you will separate yourselves 

from others by showing them you will out work their lazy behinds. Lastly, the fourth of July week is the first week 

of the 3rd quarter and you will want to get out the gate strong to continue to build your base of business. 

Thanks to marketing and your Rsms we have almost 50 speakers scheduled to come to Chicago for the live speaker 

training. Please continue to work with your Rsms to discuss the speakers in your territory. 

Key hits 

- number of units in each script are continuing to rise. Great work and let's see less and less scripts for 30 units. 

Tell docs to write the same as they would Actiq and fentora. And for the four doctors still using Abstral and 

Lazanda, well, get those patients on the best drug 

- same indication as Actiq and and fentora 

- you will make more money the more units and higher dose you sell. This is never changing so continue to discuss 

with you writers how to ensure the patient is getting proper pain relief. We have heard stories where 800 mcg of 

subsys works for some patient that was on 12000 Actiq and we have heard others says it isn't strong enough in this 

scenario. Remember, encourage your doctor to practice medicine as he or she sees fit and to use their clinical 

judgement. 

Confidential 

Finally, my apologies for the long email but the Yankees are on tv and I would rather watch House Hunters 

International in German than watch the yankees anymore. 

I am proud of of the great start and for forging the relationships we do on a daily basis. 

Please reach out if you need anything. 

My best, 

Mike 

I NS-BOS-01291403 
Confidential 

Email Message 

From: 

Sent: 

To: 

Abe Rosenberg 

Tuesday, September 25, 2012 12:11 :08 AM 

Xun (Sean) Yu 

Subject: Re: Please note you have low strength (<=400MCG) RX dispensed yesterday -

Daily Rep Report for Low Strength Usage 

Attachments: image001.jpg 

I spoke w/ Heather Alfonso and she wants to titrate slowly. She is aware of the 

statistical analysis but she going to use her best judgment on patient to patient basis. I 

will see her again this week and will make sure to deliver our new titration guide which I 

think will prove very beneficial. 

Best, Abe 

Sent from my iPad 

On Sep 19, 2012, at 10:43 AM, "Xun (Sean) Yu" wrote: 

Thank you Abe please keep me updated. Going forward if you feel a dr always 

writes low doses for a certain reason please feel free to let me know so that you do 

not have to update that particular dr all the time unless its a special case. But other 

than that I appreciate your regular input into this very important project when you 

have a low dose RX. 

Regards, 

Xun(Sean)Yu, PhD, MBA 

<image001.jpg> 

I NS-BOS-01295160 
Confidential 

From: Abe Rosenberg 

Sent: Wednesday, September 19, 2012 5:32 AM 

To:Xun(Sean)Yu 

Cc: Frank Serra 

Subject: Re: Please note you have low strength ( <=400MCG) RX dispensed 

yesterday - Daily Rep Report for Low Strength Usage 

Hi Xun, Dr. Rosenberg is sending me an email response today. Which I will forward 

along as soon as I get it. 

Sorry for the delay 

Best, Abe 

Sent from my iPad 

On Sep 11, 2012, at 12:04 PM, "Xun (Sean) Yu" wrote: 

Dear SSP, 

Attached please find the list of dispensed Subsys scripts yesterday with low 

strength (<=400MCG). Some of these low dose scripts were from your doctors. It 

is imperative that you work with your writers to titrate patients to their effective 

doses. 

Following writers had 100MCG, 60-Unit Voucher (Free Product} redeemed 

yesterday: 

Sun from 101A02 

Ruan from 103A99 

How To Read the List : 

- Date of Service: The date the script was brought into the pharmacy. 

- Processing Date: The date the script was dispensed (picked up by patient). 

Can be several days later than Date of Service. 

- NDC: Strength of the script. For example 20482-0004-30 = 400MCG, 

20482-0012-30 = 1200MCG. 

- Quantity Dispensed: Number of units (devices) dispensed to the patient. 

I NS-BOS-01295161 
Email Message 

From: Jonathan Roper 

Sent: Tuesday, February 04, 2014 10:04 PM 

To: Sunrise Lee 

Subject: Speaker info 

1. Clough- one of top writers in the company, has also had many successful ISPs in which 

Natalie was able to grow her business and increase new writer who attended the programs. 

Confidential 

2. Goldstein- Top ten writer who we have also benefited from with many succesful ISPs. Dr. 

Goldstein has also made a full commitment to his ISPs throughout the entire 2014 calender year 

3. Freedman- Top ten writer who has been with Insys since launch. Insys has also benefited from 

Dr. Freedman with many succesful ISPs. Dr. Freedman has also made a full commitment to his 

ISPs throughout the entire 2014 calender year . 

4. Alfonso- PA Alfonsos business has increased greatly since being given more spaeker 

programs and she has also helped in many new writer activations. 

5. Waghmarae- A great speaker who was praised by compliance as being the best speaker in the 

company. His business is on its way back as he puts it, now that we have the rep he requested 

working with him. 

6. Rosenberg- A veteran speaker whos business has been on the up and up, and he is also 

committed to Insys throughout the year. 

7. Griver- A great speaker who writes on a consistent basis. 

8. Shlifstein- NEW SPEAKER 

9. Thomas- NEW SPEAKER 

10. Morales-Ultrilla- Finally got a new rep in that territory who starts in 2 weeks. Business 

should grow that we also have Rebecca visiting Dr. Morales in the meantime. 

11. Hoh- ISPs have helped in new writer activations for Aimee Huber 

12. Thorson- no longer would utilize 

I NS-BOS-01368106 
Confidential 

Email Message 

From: Abe Rosenberg 

Sent: Friday, August 17, 2012 10:49 PM 

To: Michael Babich 

CC: Frank Serra 

BCC: 

Subject: RE: Re: CT - Rosenberg 

Heather Alfonso 

8/17- I saw Heather on Monday and stopped back in her office today but missed her. On Monday we 

had a nice discussion about getting more patients on Subsys and if I could bring a Speaker to our 

scheduled lunch on the 24th of August. She said absolutely but that speaker program unfortunately was 

cancelled as I'm sure you are aware. On Monday she also expressed interest in becoming a speaker for 

us and I told her I would let her know as soon as we had another training scheduled. She also was 

helping me think of places where I might do a dinner program for the CT area and which other Dr.'s 

would be good to invite. 

Dr. Rosenberg 

8/17- Dr. Rosenberg actually did a speaker program for me today in Dr. Robbin's office which I thought 

went rather well. Topics of discussion were ease of use and how quickly Subsys hits and "crushes" the 

breakthrough pain episode. Dose strengths and titration were also discussed at length. Dr. Rosenberg 

did a very organized and professional presentation and I will continue to use him as one of my speakers 

moving forward. 

Cooney 

8/17 Moved out of my Territory, DNS 

Ross 

8/17- I am trying very hard to get face time with Dr.Ross, Hazel his office manager tells me she is putting 

my weekly dropped promotional material in his mail box and he will call me for an appointment if 

interested. So far nothing has come of that. I am continuing to come up with a way to get face time 

including rep. triggered letters. I believe a dinner which are allowed in MA again would be very beneficial 

for this office and many others in the Boston area. These Harvard Dr.'s are very tight knit group and 

they all seem eager to learn about new treatments and medications. I am speaking to some of the lower 

decile Dr.'s like Dr. Pachas who I see on a regular basis. 

McGeeney, 

8/17- Does not see reps. at his new Albany location. I am attempting to contact his office manger to see 

if I can set up a meeting elsewhere. Thus far she has not returned my calls but I will keep 

trying. Similar to Dr. Ross's I feel a dinner program may be the best way to get Dr. McGeeney to the 

table. I plan to talk with Scimedica on such a dinner and perhaps they will know when dinners can be 

offered again to MA Dr.'s. 

Have a great weekend. 

Best, Abe 

I NS-BOS-01370925 
Confidential 

Email Message 

From: Abe Rosenberg 

Sent: Monday, October 01, 2012 11 :03 PM 

To: Frank Serra 

BCC: 

Subject: RE: Getting it done 

Hi Frank, here are my top three as of now. Hopeful soon to be added onto! 

Dr. Rosenberg 

Heather Alfonso 

William Pachas 

From: Frank Serra 

Sent: Monday, October 01, 2012 5: 14 PM 

To: Sales Team - Northeast 

Subject: Fwd: Getting it done 

teami need from each of you (excluding jeff and ryan), your top three "Go To" docs. 

please submit with your spreadsheets tonight. 

thanks 

frank 

Sent from my iPad 

Begin forwarded message: 

From: Alec Burlakoff

Date: October 1, 2012 3:32:51 PM EDT 

To: Sonia Palermo 

Cc: Sales RSMs Sales All 

, Michael Babich Matthew 

Napoletano 

Subject: RE: Getting it done 

Hi Sonia 

I read your below e-mail, you made my day! 

This is exactly how you create your 'go to doctor'. 

I sincerely appreciate your willingness to try something a little different, as subtle 

change is definitely the way to long term success. 

Congratulations on finding a 'healthy' way to create a quality selling opportunity; 

with a clinician whom will soon be your 'TOP DECILE' target! 

INS-BOS-01371417 
Confidential 

Have a great day 

Alec 

-----Original Message-----

From: Sonia Palermo 

Sent: Monday, October 01, 2012 12: 19 PM 

To: Alec Burlakoff 

Subject: Getting it done 

Hey Alec I'm following your lead. I met with doctor Steven Litman today. I got 

him super excited about the super vouchers. He has not written a script for me 

yet. But I am pretty confident by the end of the quarter he will be be one of my 

go to doctors. I made plans with him to run together every Monday night at 5 pm. 

He is looking to get back in shape so I told him that I promised i could help him 

get to his goal. I am sure he will help me get to mine as well:) Thanks for the 

motivation I am out if finding my go-to doctors. I know there out there. 

Sonia Palermo 

Sent from my iPad 

INS-BOS-01371418 
Email Message 

From: Frank Serra 

Sent: Friday, October 12, 2012 6:23 PM 

To: Lindsay Couturier 

BCC: 

Subject: RE: List 

Lindsay, 

Abe is going to call you, Heather Alfonso is in.+ 

All geared up, in fact, she wants to know if she needs to study anything to prepare. 

Thanks, 

Frank 

Frank R Serra 

Northeast Regional Sales Manager 

iNSYS Therapeutics, Inc. 

From: Lindsay Clancy 

Sent: Friday, October 12, 2012 11:41 AM 

To: Frank Serra 

Subject: RE: List 

Thanks Frank. 

Looking forward to hearing back. 

Best Regards, 

,t~~ 

Confidential 

Marketing and Sales Communication Specialist 

From: Frank Serra 

Sent: Friday, October 12, 2012 6:31 AM 

To: Lindsay Clancy 

Subject: RE: List 

Sure thing Lindsay. 

INS-BOS-01372194 
Confidential 

Email Message 

From: Abe Rosenberg 

Sent: Wednesday, October 17, 2012 11 :41 PM 

To: Frank Serra 

BCC: 

Subject: 1 rx per day 

Attachments: 1 rx per day.xls 

No new script today. But i'm getting close. I have copay cards in folders waiting for Actiq patients to 

come in!! Heather Alfonso has promissed me she will switch all Actiq patients and I text her every 

morning to remind her as well as visit her 2 to 3 per week. They will come!! 

Frank can we chat tomorrow I need some clarification on a few items? 

I NS-BOS-01372372 
Email Message 

From: Frank Serra 

Sent: Sunday, December 02, 2012 5:19 PM 

To: Abe Rosenberg; Jeff Pearlman; Katarina Haumesser; Michelle Breitenbach; Nanette Alonzo; 

Rebecca Haas; Ryan Mitchell; Sonia Palermo; Susan Beisler 

BCC: 

Subject: FW: IMPORT ANT I Immediate Attention 

Attachments: Bring A Patient on SUB SYS, Get Paid Multiple Quarters.pptx 

Team, 

A reminder on the slide attached. 

As well, the bigger the script the more money you make. 

What we used to call at my uncle tony's beer store, "Cash on the Barrel Head". 

Why do you think Jeff's inspection sticker expired, he was making sure a 90/1200 script got filled. 

Now he'll earn enough to pay off the judge and the OMV!! 

Thanks, 

Frank 

Frank R Serra 

Northeast Regional Sales Manager 

iNSYS Therapeutics, Inc. 

From: 

Sent: Wednesday, November 14, 2012 12:26 PM 

To: Frank Serra; Darin Fila; Sunrise Lee; Joseph Rowan; Richard Simon 

Cc: Michael Babich; Matthew Napoletano 

Subject: IMPORTANT/ Immediate Attention 

Managers 

This weeks script count is down. I believe it is because the reps are holding back on giving the 

30 free unit and super vouchers because they feel it will negatively impact their bonus. THIS IS 

NOT WHAT I WANT. 

Confidential 

I need you assistance in making sure the reps think 'big picture'. 

I have already spoken with some of you, I need to speak continuously with all of you to make 

sure the sales force is following the company's direction. 

I will be in the office tomorrow and Friday. 

I will also be in the office next week ( Mon, tues, and wed) 

I need this message conveyed today. I have even heard some of you say" ifl were a rep- I would 

do the same thing". 

INS-BOS-01377055 
Confidential 

I appreciate and need your honestly, so I can plan accordingly. However- now that it is all on the 

table ....... . 

I NEED you to make sure every rep is evaluated on the utilization of the various sales tools we 

provide. I.e. SUPER VOUCHERS 

The reps do not get to do it "their" way. They follow the company line or they go on a "PIP". 

The bonuses in Q4 will be very strong. This is because the reps followed the plan all the way to 

fruition. We all need to stick with the plan! 

Thank you 

Alec 

Sent via BlackBerry by AT&T 

From: "Xun (Sean) Yu" 

Date: Wed, 14 Nov 2012 09:36:44 -0700 

To: Michael Babich<m Alec Burlakoff<f

Cc: Mike Gurry Matthew Napoletano

Subject: RE: draft (Sean, please in) IMPORT ANT 

Please see below Mike and Alec. All numbers assume: 1) net sales 2) 10% bonus share 

Also please see slide attached for "patient as annuity". 

My two cents is reps should know firstly they are not forced to use vouchers. If they can get all patients 

started on insurance (like Katie with Dr Waghmaere) then that's better for everyone. However vouchers 

are a great tool for reps to help them sell and start new patients, and like other good tools (such as iPad) 

they should not expect to get paid just because they are using them. 

Regards, 

Xun (Sean) Yu, PhD, MBA 

Dir. Sales Operations 

I: . inSYS 

From: Michael Babich 

Sent: Wednesday, November 14, 2012 9:20 AM 

To: Alec Burlakoff; Xun (Sean) Yu 

Cc: Mike Gurry; Matthew Napoletano 

Subject: draft (Sean, please in) IMPORTANT 

INS-BOS-01377056 
Confidential 

I would like simple message like the below to go out from Alec today in email and voicemail. Any 

rumblings that vouchers and SV's hurt their business is complete garbage. This message needs to 

communicated clearly and today. Sean, please fill in the bonus amounts on the scripts. Put all the 7 

doses in there if need be so we provide them true clarity. The concept of the below can be adjusted by 

anyone on here so send Alec and I suggestions right away. I want this out there, simple and straight 

forward and the RSM's need to drive this home today, not tomorrow. 

In an effort to provide more clarity on how to succeed, the bonus plan is structured on net sales which is 

commercially insured paid scripts. Here a few examples, 

120 units of 100 mcg is worth $283 of bonus 

120 units of 200 mcg is worth $358 of bonus 

60 units of 600 mcg is worth $337 of bonus 

60 units of 800 mcg is worth $415 of bonus 

90 units of 800 mcg $623 

120 units of 1200 is worth $1147 of bonus 

120 units of 1600 is worth $1464 of bonus 

How do you get to this point? 

1. Start a patient on 30 free units. Even though you are giving 30 free units, many times the 

insurance still picks up this claim and it gets paid. If it does, you get paid 

2. PA, get patient approved for the long term 

3. Focus to ensure the patient reaches the effective dose and has enough monthly supply 

I have heard some reps comment that super vouchers and initiations will hurt their net revenue? I can 

honestly say that this statement is absurd. Why? The more patients you start and properly track, the 

more success you will have long term. 

Did you see Mike Gurry's email? Almost 40% of Actiq switches have already been approved by the PA 

process! These reps whom have sold the actiq switch not have a patient that will most likely be on 

Subsys for over a year. You get paid every single time a script comes through. 

Michael Babich 

President and CEO 

NS-BOS-01377057 
Confidential 

An average patient stays on ROO therapy for 9 -

12 months since inception of treatment. That's 3 

- 4 quarters worth of monthly sales to you, an 

annuity that keeps paying 

For each SINGLE patient on SYBSYS, you will make: 

Quarter 1 * Quarter 2 * Quarter 3 * Quarter 4 * 

NOTE: * Assuming 1 TRx per patient per month at 400MCG; 75 units per TRx; as 

well as IC plan based on 10°/o net sales. 

For internal planning purposes only I 

INS-BOS-01377058 
Confidential 

See how your payout will differ if the patient is on 

100MCG, 400MCG, or 1200MCG doses throughout the 

course of the therapy 

And remember, higher doses also mean more units/TRx * 

Quarter 1 Quarter2 Quarter3 Quarter 4 

··:.::.,_.·. ·}'· 

.. p· 

:] ·.:> 

NOTE: * For all ROO products, 1 OOMCG TRx has on avg. 48 units; 400MCG 

TRx has 75 units; while 1200MCG TRx has 82 units (WK 2012 Data). 

All assumptions and conditions in the previous page apply. 

For internal planning purposes only 2 

INS-BOS-01377059 
Confidential 

Email Message 

From: Abe Rosenberg 

Sent: Monday, April 08, 2013 12:49 AM 

To: Jeff Pearlman 

Subject: Swat 

Strengths: 

• Strong relationship w/ my number one Doc. Dr Rosenberg 

• Strong Relationship w/ Glen and Linden Care 

• Built a strong relationship with Heather Alfonso decile 9 

• Developing strong relationship with new Dr+s should lead to more writers 

Weakness: 

• Need more writers wider base 

• Need to find more commercially insured patient population 

• Take more advantage of switch program 

Opportunities: 

• Dr. Robbins 

• Dr. Levin 

• Dr. Braylovsky 

• Dr. Kost 

• Dr. Rosenberg doing Grand Rounds on Cancer pain in the RI area. 

Threats: 

• Fentora Rep. Free loading off my hard work of getting Fentanyl Citrate Patients converted. 

• Lazanda: Launch 

Slides via lpad soon to follow. 

Abe Rosenberg 

Specialty Sales Professional 

Insys Therapeutics, Inc. 

I NS-BOS-01404181 

Confidential 

• Dr. Rosenberg is available for lunches Mondays, Tuesdays, Wed. and Fridays. Not sure how we 

are going schedule those. As I need to confirm which offices are available on those dates for 

lunches. And I do not want random calls to my offices that I am building relationships 

with. With that being said Dr. Rosenberg and myself have worked well together lately to target 

offices not in our lists for lunches that should translate into scripts and are happy to work with 

you and Emily to schedule more lunches. 

• Dr. Rosenberg is available for dinners Mondays and Wed. after 6pm. He does not like Tues. but 

will make that work if need be. 

Heather Alfonso 

• To date she has influenced two prescribers to write. Dr. Feldman and Liza Paolini, Both have 

written multiple scrips and have committed to continue to write. 

Heather is not available for lunches as she does not make her own schedule. She is available for dinners 

Mondays Tuesdays and Wed. after 6pm with enough notice. However I need to speak with her about 

which venue or venues work best for her. I have not done that many programs in CT and it a very large 

state. We may need to have two venues dependent on the target audience. Unfortunately, since we 

didn't get the original email until Wed. evening. and Heather was already in New Orleans I have not 

been able to speak with her and don't want to bother her until her return early next week. If that is ok 

with you? 

Abe Rosenberg 

Specialty Sales Professional 

Insys Therapeutics, Inc. 

From: Jeff Pearlman 

Sent: Wednesday, May 08, 2013 6:34 PM 

To: Sales Team - NYC 

Subject: speakers ASAP 

As I prepare the budgeting for the ISPs, I am taking this approach as used by another RSM ..... 

Team, 

In preparation for Q3 budget planning: 

+ I would like each of you to send me a list of your speakers and to the best of your 

ability please share with me the names of the physicians that these speakers have 

influenced to write and if they are repeat writers 

+ Please also send the name and address, contact of each restaurant you plan to use 

for each speaker moving forward for both lunch and or dinner venues 

+ Finally please provide the days of the week the dr. is willing to speak. Lunch, 

dinner etc. 

Please have this in to me by End of business Friday(Ifyou need weekend time I am OK with 

that, as long as I have it no later than Sunday night, no delays). 

I NS-BOS-01417 446 

Confidential 

Email Message 

From: 

Sent: 

To: 

Cc: 

Subject: 

Attachments: 

Hi Jon 

JW Scherm 

Tuesday, April 28, 2015 8:33 PM 

Jonathan Roper; Jessica Crane 

Kianna Riley; Desiree Hollandsworth; Denise Schuck 

Heather Alfonso no longer active. 

Heather Alfonso.xis 

Per our conversation attached is a spreadsheet of 5 program I have with Heather Alfonso scheduled as 

the speaker. By an update I received today from lnsys Ms. Alfonso is no longer active. 

Informing Kianna of this she had just talked with Jessica a short while ago. Apparently they touched 

base previously. We are holding all planning of these until receiving further direction. Please note the 

next closest program is currently shows the date as May 12. 

Thank you, 

JW Scherm 

JW Scherm I Account Manager I Plan 365, Inc. 

NS-BOS-01433435 
Email Message 

From: 

Sent: 

To: 

Subject: 

Importance: 

Hello Jessica, 

Kianna Riley 

Tuesday, April 14, 2015 7:59 PM 

Jessica Crane 

Upcoming Alfonso Programs 

High 

How are you? I hope you+ve been enjoying your day. 

I wanted to send you an updated list of all the programs that are scheduled with Heather Alfonso as the speaker. Please let me know if we 

should cancel the programs or if another speaker will replace her for some of the ones taking place in the next few weeks. 

See below: 

8067 AP3015E 04/30/2015 Dinner Work-in-Progress Laskara Restaurant Wallingford CT Heather Alfonso 

8067MA0615E 05/06/2015 Dinner Work-in-Progress Caseus Fromagerie Bistro New Haven CT Heather Alfonso 

8067MA 1215E 05/12/2015 Dinner Work-in-Progress The Library Wine Bar and Bistro Wallingford CT Heather Alfonso 

8067MA 1415E 05/14/2015 Dinner Work-in-Progress ROIA Restaurant and Cafe New Haven CT Heather Alfonso 

8067MA 1915E 05/19/2015 Dinner Confirmed Grant's Restaurant West Hartford CT Heather Alfonso 

8067JN0415E 06/04/2015 Dinner Work-in-Progress Restaurant Bricco West Hartford CT Heather Alfonso 

8067JN1015E 06/10/2015 Dinner Work-in-Progress Treva West Hartford CT Heather Alfonso 

8067JN1815E 06/18/2015 Dinner Work-in-Progress Michael's Trattoria Wallingford CT Heather Alfonso 

8067JN2415E 06/24/2015 Dinner Work-in-Progress ROIA Restaurant and Cafe New Haven CT Heather Alfonso 

Confidential I NS-BOS-01433609 
Speaker Program ROI 

2012 and 2013 (thru 3/28) Attendees 

Overall analysis (N = 692) 

• 692 attendees (matched to NPI). 

o 2,781 TRxs and $7,712,867 Rev o $11,146 Rev/attendee o 4.02 TRx/attendee o 207 (30o/o) have written at least one TRx. 

Prescriber Analysis (n = 207) 

• 207 (30°/o) have written at least one TRx 

o 2,781 TRxs and $7,712,867 Rev o $37,260 Rev/attendee with at least one TRx o 13.43 TRx/attendee 

Other Findings 

• Those who attend multiple ISPs are more prolific - 8.61 TRx/attendee 

17.63 TRx/attendee >1 program 

• Of the 207 with ~1 TRx 

o 120 (58°/o) wrote at least one TRx prior to their first ISP attendance. o 84 ( 42%) did not write a TRx until after their first ISP 

• Avg time from ISP to first TRx was 95 days (min O days & max 273 days). 

• 683 TRxs and $1 ,869,037 Rev 
Strategic Imperatives 

3,500 

Active 

Targets 

Inactive 

Targets 

Oncology 

Prospects 

The number of new prescribe rs must grow to maintain the 

rate of growth necessary to meet our objective 

The core group of prescribers must be nurtured and protected. 

With a relatively small number of core prescribers, we must 

maintain their current business and seek additional 

opportunity 

The patients that are prescribed SUBSYS need to be 

optimized by removing financial barriers and ensuring 

positive experience with SUBSYS 

The growth of SUBSYS cannot be maintained if the competition 

is chipping away at the current and/or future book of business. 

Minimizing competitive impact with current and future 

prescribe rs is essential. 

•·•·•······•·•••··• I 

·······································1 

•••••••••••••••••••••••••••••••••••••••I 

I NSYS _HSGAC _ 00006045 
TRxs & ISPs 

2012 TRXs & ISPs 

Spkr Training 

1,200 1,000 

800 

600 

400 

200 

~~~~-JC-~~~~~~~~~------1~--...--end-l=

Inflection 

\"" t>,. '"" '"" <o \"" \"" 'b '"" 0) \"" ",,\) '"" ",, 

- TRxs - ISPs 
Speaker ROI 

LTD 12/6/12: Total Active Speakers 

Tot Active 

Region k 4Q Mkt Share Tot Programs Net Rev Honor 

Spea ers 

Total: 141 29°A, 349 $ 4,183,616 $ 554,60

NE 28 29% 75 $ 1,491,611 $ 105,60

SE 36 39% 102 $ 910,252 $ 169,4

MA 28 43% 42 $ 459,465 $ 62,60

C 28 19% 73 $ 574,715 $ 117,6

w 21 19% 57 $ 747,573 $ 99,40

• ROI Assessment 

o Captured 29% ROO Share of speakers (3Xs > overall ROO Market Share) o Speakers generated $4.2M Net Rev LTD (60% of total net) 

• Speakers with programs generated -6Xs more revenue per prescriber than those w

o Speakers received $554,600 total honoraria 

o 7.5:1 ROI , Honoraria to Net Rev (5:1 ROI Tot Prog Exp to Net Rev) 

• 11 :1 ROI, Honoraria to Gross Rev (7:1 ROI Tot Prog Exp to Gross Rev) 

• Regional Assessment 

o All Regions have an ROI of~ 5:1 

o NE doing best with ROI at 14: 1 (largely due to Spags, Wags, & Nicholson) 
Speaker ROI Management 

LTD 12/6/12: Total Active Speakers 

Tot Active 

Region k 4Q Mkt Share Tot Programs Net Rev Honor 

Spea ers 

Total: 141 29°A, 349 $ 4,183,616 $ 554,60

NE 28 29% 75 $ 1,491,611 $ 105,60

SE 36 39% 102 $ 910,252 $ 169,4

MA 28 43% 42 $ 459,465 $ 62,60

C 28 19% 73 $ 574,715 $ 117,6

w 21 19% 57 $ 747,573 $ 99,40

• Flagged all speakers with ROI less than 2: 1 

0 Identified speakers to put temporary hold-on programming 0 Identified candidates to consider to "soft delete" 

• Identified speakers with revenue > $5K and no programs - to target p
Speaker ROI Management 

LTD 12/6/12: Total Active Speakers 

Tot Active 

Region k 4Q Mkt Share Tot Programs Net Rev Honor 

Spea ers 

Total: 141 29°A, 349 $ 4,183,616 $ 554,60

NE 28 29% 75 $ 1,491,611 $ 105,60

SE 36 39% 102 $ 910,252 $ 169,4

MA 28 43% 42 $ 459,465 $ 62,60

C 28 19% 73 $ 574,715 $ 117,6

w 21 19% 57 $ 747,573 $ 99,40

• Flagged all Regions with low ROI 

0 Identified speakers to put temporary hold-on programming 0 Identified candidates to consider to "soft delete" 

• Identified speakers with no programs >$5K and no programs - to targ
Confidential 

INSVS Speaker Program Compliance 

Monitoring Report 

Presented to 

February 25, 2014 

By 

Compliance Implementation Services 

CONFIDENTIAL 

INS4289770 

I NSYS _HSGAC _ 00007773 
INSYS Speaker Program Compliance Monitoring Report 

Table of Contents 

Introduction .......................................................................................................................................................... 3 

Project Objective and Scope .................................................................................................................................. 3 

Project Methodology ............................................................................................................................................. 4 

Observations Overview ......................................................................................................................................... 5 

Summary of Speaker Program 1 ............................................................................................................................ 6 

Summary of Speaker Program 2 ............................................................................................................................ 6 

Summary of Speaker Program 3 ............................................................................................................................ 7 

Summary of Speaker Program 4 ................................ ............................... .. . ........................................................ 7 

Summary of Speaker Program 5 ................................ ........................... . ....................................................... 8 

Summary of Speaker Program 6 ...................................................... · 

Summary of Speaker Program 7 ................................................. ' 

Summary of Speaker Program 8 .............................................. . 

Summary of Speaker Program 9 ...................................... . 

Conclusion .................................................................. . 

Appendix A: Speaker Program 1 Checklist ................... . 

Appendix B: Speaker Program 2 Checklist ........................ . 

Appendix C: Speaker Program 3 Checklist. ............................ . 

Appendix D: Speaker Program 4 Checklist. 

Appendix E: Speaker Program 5 Checklist.. .. . 

Appendix F: Speaker Program 6 Checklist ....... . 

Appendix G: Speaker Program 7 Checklist ......... . 

Appendix H: Speaker Program ·st ............ . 

Appendix I: Speaker Progra 

Appendix J: Documentatio 

Page 2 of 41 

Confidential 

............................................................ 8 

.......................................................... 9 

. .................................................... 9 

. ............................................. 10 

. ......................................... 10 

. .................................... 11 

. ............................... 14 

. ........................... 16 

Confidential 

INS4289771 

INSYS HSGAC 00007774 - -
INSYS Speaker Program Compliance Monitoring Report 

Introduction 

Project Background 

INSYS Therapeutics, Inc. (INSYS) is a specialty pharmaceutical company that develops and commercializes 

innovative supportive care products that target the unmet needs of cancer patients, with an initial focus on 

cancer-supportive care. INSYS launched its first two products in the United States in 2012; SUBSYS®, a proprietary 

sublingual fentanyl spray for breakthrough cancer pain in opioid-tolerant patients and Dronabinol SG Capsule, a 

generic equivalent to Marino!, an approved-second line treatment for chemotherapy-induced nausea and 

vomiting and anorexia associated with weight loss in patients with AIDS .. 

INSYS engages Healthcare Professionals (HCPs), via Speaker Progra" 

label product information to HCPs and other external parties on 

approximately one thousand (1,000) speaker programs a year· 

compliance program to be meaningful and sustainable it 

acknowledges the importance to perform monitoring~ 

contracted with Compliance Implementation Service 

a percentage of those programs throughout the year to 

applicable standards, laws, regulations, and INSYS policies 

INSYS has identified a need for dedicated r 

ovide scientific, disease state, onct SUBSYS®. INSYS will conduct 

tSUBSYS® and recognizes for a 

· icant to all employees. INSYS 

aker programs. As such, INSYS 

oring program by observing 

assistance in meeting the on-going 

art of the Speaker Program Compliance 

in Q4 2013. This monitoring project 

delivery of this draft report on 

the project and CIS' observations. 

The scope a 

2013, base 

con ng of fifteen (15) speaker programs to audit in Q4 

has well andom sampling approach, to ensure compliance 

g INSYS policies and Standard Operating Procedures (SOPs), and 

and interactions with Health Care Professionals (HCPs). 

1toring the INSYS Speaker Programs. They include, but are not 

• ntended and necessary to fulfill a legitimate, unmet business need for 

speaking services. 

• Speaker Programs must an educational benefit to the audience, present accurate and truthful 

information within the pro ct's FDA approved labeling, be fair and balanced, and disclose relevant 

safety information, warnings and side effects. 

• Participation in Speaker Programs must not be offered to prospective speakers or speaker program 

attendees as a reward or inducement for past or future prescribing, purchasing, recommending for 

formulary placement, or arrangement for the purchase or sale of a INSYS product or service. 

Page 3 of 41 

Confidential 

Confidential 

INS4289772 

INSYS HSGAC 00007775 - -
INSYS Speaker Program Compliance Monitoring Report 

Documentation, Interview, & Live Monitoring Scope: 

CIS reviewed the following policies and procedures that INSYS provided related to their internal requirements 

governing speaker programs, and interactions with HCPs. CIS also collected functional data for the audit which is 

listed below, to gain a better understanding of processes and requirements as they related to INSYS Speaker 

Programs. 

SOP #SBM 1 Speaker Bureau Management 

PPT-Training Advancements in the Treatment of Breakthrough Pain in Cancer Patients (BTCP) 

PPT-Training Supplemental Speaker Deck Slides 

PPT-Training INSYS Speaker Programs (ISP) (Non-CME Pee 

Project Methodology 

The methodology outlined below was used for the Sp 

• Planning 

o CIS collected and reviewe ing as determined 

by INSYS. 

o CIS attended the INSYS Speak th, 2013, 

ker program materials presented at 

vancements in the Treatment of 

e upplemental slides regarding "Prior 

protocols and set expectations related to the 

t. 

ivities throughout the 

ailed project plan for the engagement which acted as a living 

• Fieldwork 

o CIS review s of Speaker Programs to evaluate against pre -determined 

criteria bas policies and SOPs, and industry best practices related to speaker 

programs and i ons with HCPs . 

./ CIS sele ed programs based on a risk-based targeting approach and random sampling 

approach 

./ For each Speaker Program, CIS reviewed slide materials, speaker statements, and 

INSYS representative statements to verify compliance with regulations, policies, and 

procedures 

• Reporting 

o CIS completed a Speaker Program Monitoring Chee klist at the conclusion of each Speaker 

Program 

o CIS communicated any high risk concerns promptly 

Page 4 of 41 

Confidential 

Confidential 

INS4289773 

INSYS HSGAC 00007776 - -
INSYS Speaker Program Compliance Monitoring Report 

Observations Overview 

Due to cancellations and rescheduling of several Speaker Programs, CIS selected a total of twenty two (22) 

Speaker Programs to monitor. Of these 22 programs, CIS was able to successfully monitor nine (9) programs. A 

total of thirteen (13) programs were cancelled and/or rescheduled; eight (8) of the cancelled programs were 

cancelled after the CIS Monitor traveled to the program site, and had confirmed the Speaker Program prior to 

travelling; and the remaining five (5) of the cancelled programs were cancelled prior to the scheduling of travel by 

the CIS Monitor. 

Of the eight (8) cancelled programs which included CIS Monitor travel, to 

the INSYS Sales Representatives and/or Speakers; three (3) of the pro 

cancellation; and one (1) program did not occur because the INSYS 

attendees did not attend the scheduled Speaker Program. 

CIS has summarized all eight (8) Speaker Programs monit 

that during all Speaker Programs, the Speakers and INS 

knowledge and were able to control the conversatio 

at hand. All Speakers used the INSYS approved slide pre 

All presentations were thirty five (35) min 

programs which requires that the program 

Page 5 of 41 

Confidential 

(4) of the programs were cancelled by 

ere cancelled due to attendee 

sections of this report. CIS noted 

onstrated product 

volved around the subject 

rams were off-site 

Confidential 

INS4289774 

INSYS HSGAC 00007777 - -
INSYS Speaker Program Compliance Monitoring Report 

Summary of Speaker Program 1 

Program Logistics and General Information 

The first Speaker Program that CIS was able to monitor occurred at 7:00 PM on Monday, November 4, 2013 at 

Vietnam Restaurant in Corpus Christi, Texas. The INSYS Sales Representative at the program was Ty Rustin and 

the speaker was Dr. Judson Sommerville. A total of six (6) individuals took part in the program and the meal; this 

includes the CIS Monitor, the INSYS Sales Representative, the Speaker, and two (2) other HCPs from the Speaker's 

office. The total dollar amount for the dinner program is unknown by CIS as the dinner was pre-paid by INSYS. 

Program Overview 

The presentation was displayed by the speaker using a tablet but was 

tablet often, and did not turn it around for others to see specific sli 

approximately twenty-nine (29) minutes in length with an additi 

Speaker did use the approved slide deck but did not specificall 

that the Speaker read from the 

s graphs and data. The program was 

3) minutes for a Q&Asession. The 

approved slide deck; he mostly 

spoke to his own knowledge of the product. The Speaker 

however, the presentation was severely lacking in cont 

moderately busy with normal patrons during the pro 

others sitting at tables within arm's length. 

See the checklist for this program in A 

Summary of Speaker Program 2 

Program Logistics and Gen 

The second Speaker Progr 

at the office of Dr. Darshan 

ivery of the product information; 

ation. The venue was 

the speaker was audible by 

rre at PM on Thursday, November 7, 2013 

INSYS Sales Representative at the program was 

r. A total of five (S) individuals took part in the 

esentatives (one INSYS Sales Representative was 

other HCP. According to the Program Sign-in 

program; this i 

shadowing f 

Sheet, ther uals from · office that took part in the meal but did not attend 

Program Overview 

9. 72. The total cost divided by the five individuals that attended 

$20.00 allowed per attendee for breakfast/lunch programs. 

The presentation was dis aker using a tablet and was approximately eight minutes in duration, 

which is far under the recom ation for in-office programs. The INSYS Sales Representative introduced 

the speaker and informed the s that the speaker uses SUBSYS® and that he will be providing further 

information on the product. However, there was no clear disclosure to the attendees that the program was 

sponsored by INSYS. Dr. Monoj Patharkar started the discussion by providing a brief history of Fentanyl, and then 

continued with specific product information such as how SUBSYS® is administered and its indications. Safety 

information was not discussed at all during the presentation. The Speaker Program attendee asked if SUBSYS® 

was only used for breakthrough pain in cancer patients and the attendee was informed that breakthrough cancer 

pain in cancer is the only indication approved by FDA. 

See the checklist for this program in 

Page 6 of 41 

Confidential 

Confidential 

INS4289775 

INSYS HSGAC 00007778 - -
INSYS Speaker Program Compliance Monitoring Report 

Summary of Speaker Program 3 

Program Logistics and General Information 

The third Speaker Program that CIS was able to monitor occurred at 11:30 AM on Tuesday, November 19, 2013 at 

the office of Rockwood Oncology in Spokane, Washington. The INSYS Sales Representative at the program was 

Kristiana Wright and the speaker was Dr. John Hatheway. A total of six (6) individuals took part in the program 

and the meal; this includes the CIS Monitor, the INSYS Sales Representative, the Speaker, and three (3) other 

HCPs. The total dollar amount for the dinner program is unknown by CIS as the dinner was pre-paid by INSYS. 

Program Overview 

The Speaker was present in the office for approximately two hours wi 

quickly pass through to hear the presentation. A total of three (3) 

times. The first HCP attended the program for 6:32 minutes; th 

minutes; and the last HPC attended the program for 8:23 min 

xpectation that five (5) HCPs would 

part in the program during different 

attended the program for 9:24 

each HCP did not have ample time to 

attend a full program, the Speaker was still able to effecti roved INSYS presentation, along 

with specific usage and safety information. 

See the checklist for this program in Appendix C. 

Summary of Speaker Program 4 

Program Logistics and General Information 

The fourth Speaker Program t sable to 

Devon Seafood Grill restau 

Ben Ecker and the speake 

meal; this includes the CIS M 

total bill for the dinner was $38 

$63.68 per per 

Program 0 

n Tuesday, November 26, 2013 at 

es epresentative at the program was 

took part in the program and the 

ative, the Speaker, and three (3) other HCPs. The 

the six individuals that attended the program is 

ndee for dinner programs. 

The CIS Moni presentation portion of the program. The program was 

originally schedu 

receipt, CIS noted t 

PM and therefore did 

but w cheduled to an earlier time. Per review of the copy of 

enced r ughly at 5:23 PM. CIS was not notified of 1he change until 5:20 

tion until 6:15 PM. Upon arrival, the speaker notified the CIS Monitor 

inutes in length and was presented using a tablet. 

Due to the change in start time rogram, the CIS Monitor could only review the presentation slides. The 

CIS Monitor noted that the slides presented during the program were consistent with the INSYS approved slides. 

See the checklist for the program in Appendix D. 

Page 7 of 41 

Confidential 

Confidential 

INS4289776 

INSYS HSGAC 00007779 - -
INSYS Speaker Program Compliance Monitoring Report 

Summary of Speaker Program 5 

Program Logistics and General Information 

The fifth Speaker Program that CIS was able to monitor occurred at 7:30 PM on Monday, December 2, 2013 at 

Ruth Chris Steakhouse in Sarasota, Florida. The INSYS Sales Representative at the program was Dan Tondre and 

the speaker was Dr. Dwight Fitch. A total of seven (7) individuals took part in the program and the meal; this 

includes the CIS Monitor, the INSYS Sales Representative and the Area Business Liaison, the Speaker, and three 

(3) other HCPs. The total bill for the dinner was $700.00. The total cost divided by the seven individuals that 

attended the program is $100.00, which is the exact amount allowed per attendee for dinner programs. 

Program Overview 

A copy of the presentation was provided to all attendees prior tot 

approximately thirty-two (32) minutes in duration with a Q&A s 

which is slightly under the forty five (45) minute recommende 

beginning of the presentation, the INSYS Sales Represent 

attendees that the Speaker will provide details regardi 

program was sponsored by INSYS. The speaker provi 

provided specific product information. The speaker spe 

and mainly focused on accidental exposure. The Speaker 

with back pain for which SUBSYS® was effe 

ssing safety information 

regarding a patient 

t cancer patient. 

red at 7:00 PM on Thursday, December 12, 2013 at 

Serrano an 

and them 

Program Overview 

presentative at the program was Fernando 

of seven (7) individuals took part in the program 

les Representatives (one INSYS Sales Representative 

District Manager, the Speaker, and two (2) other HCPs .. The 

mis wn by CIS as the dinner was pre-paid by INSYS. The CIS 

entativ s choice of venue was poor; the program was held in the 

hich made the presentation nearly inaudible. 

The presentation was displayed speaker using a tablet and was approximately thirty three (33) minutes in 

length. The INSYS Sales Representative stated that he had passed out the approved INSYS documents for review 

by the attendees, however the CIS Monitor did not witness the speaker provide a copy of the presentation to all 

HCPs present at the program. This particular program did not have a specific Q&A session, however questions 

were asked by HCPs during the presentation. The Speaker was able to effectively control the conversation, and 

also provided a good transition from section to section. The Speaker thoroughly explained product uses, 

indications and titration, as well as all safety information. 

See the checklist for the program in 

Page 8 of 41 

Confidential 

Confidential 

INS4289777 

INSYS HSGAC 00007780 - -
INSYS Speaker Program Compliance Monitoring Report 

Summary of Speaker Program 7 

Program Logistics and General Information 

The seventh Speaker Program that CIS was able to monitor occurred at 6:30 PM on Friday, December 13, 2013 at 

Capitol Grill restaurant in Manhattan, New York. The INSYS Sales Representative at the program was Fernando 

Serrano and the speaker was Dr. Steve Fanto who had been flown in from Scottsdale, Arizona at INSYS request. A 

total of seven (7) individuals took part in the program and the meal; this includes the CIS Monitor, two (2) INSYS 

Sales Representatives and one (1) District Manager, the Speaker, and two (2) other HCPs. Two INSYS Sales 

Representatives were present because one of the representatives is new to INSYS and was job shadowing. The 

total dollar amount for the dinner program is unknown by CIS as the din r was pre-paid by INSYS. 

Program Overview 

The presentation was displayed by the speaker using a tablet a 

in length. This particular program did not have a specific Q&A 

during the presentation. The Speaker was able to effectiv 

transition from section to section. The Speaker thorou 

well as all safety information. The speaker was able t 

with respect to safety, product information such as lyp 

knowledge and was able to bring the conversation back to 

noted that the only HCP really listening to 

and would never see a use other than off-la 

Summary of Speaker Pro 

ximately twenty seven (27) minutes 

er questions were asked by HCPs 

sation, and also provided a good 

indications and titration, as 

eep the conversation going 

onstrated product 

ed off. The monitor 

orts medicine MD, 

ed at 12:00 PM on Wednesday, December 18, 

, California. The INSYS Sales Representative at 

the progra speaker Dr. Ravi Panjabi. A total offive (S) individuals took 

part in the pr 

Speaker, and on 

not at least twelve 

Program Overview 

CIS Monitor, two (2) INSYS Sales Representatives, the 

ere were two (2) INSYS Sales Representatives, there were 

liar amount for the lunch program is unknown by CIS, however the 

The presentation was displayed speaker using a tablet and was approximately twenty six (26) minutes in 

duration with a Q&A session of approximately five (S) minutes in length. The INSYS Sales Representative 

introduced the speaker and informed the attendees that the Speaker will be providing further information on the 

SUBSYS® product. However, there was no clear disclosure to the attendees that the program was sponsored by 

INSYS. The Speaker was able to effectively control the conversation, and also provided a good transition from 

section to section. The Speaker explained product uses, indications, as well as all mandatory safety information. 

Page 9 of 41 

Confidential 

Confidential 

INS4289778 

INSYS HSGAC 00007781 - -
INSYS Speaker Program Compliance Monitoring Report 

Summary of Speaker Program 9 

Program Logistics and General Information 

The ninth Speaker Program that CIS was able to monitor occurred at roughly 8:30 PM on Thursday, December 19, 

2013 at Prime Bistro restaurant in Lawrence, New York. The INSYS Sales Representative at the program was 

Sonia Palermo and the speaker was Dr. Phillip Pyman. A total of five (5) individuals took part in the program and 

the meal; this includes the CIS Monitor, one (1) INSYS Sales Representatives, the Speaker, one (1) HCP, and the 

Speaker's office manager/wife. CIS noted that although there were two (2) INSYS Sales Representatives, there 

were not at least twelve (12) HCPs. The total bill for the dinner was $500.00. The total cost divided by the five 

individuals that attended the program is $100.00, which is the exact amo nt allowed per attendee for dinner 

programs. 

Program Overview 

The Speaker Program was approximately twenty seven (27) mi 

approximately five (5) minutes in length. Copies of the pr 

beginning of the program and later collected. The INSY 

informed the attendees that the Speaker will be prov 

Speaker provided a brief overview of the history of fent 

Speaker was able to effectively control the conversation, a 

section. The Speaker explained product us 

Speaker also made a direct comparison wit 

Conclusion 

·on with a Q&A session of 

. inated by the Speaker at the 

ucedthespeakerand 

UBSYS® product. The 

from section to 

ation. The 

eaker Programs, CIS noted that during all nine 

Speaker Progra 

All Speakers used t 

approved slide deck. 

Page 10 of 41 

Confidential 

emonstrated great product knowledge and were 

evolved around the subject at hand. A majority of 

sections ·provided an adequate amount of information on 

most instances, CIS did not note off-label discussion during the 

al information regarding dosages, and patient experiences. 

presen ation for the Speaker Programs and did not deviate from the 

Confidential 

INS4289779 

INSYS HSGAC 00007782 - -
Checklist 

Program LogisticG 

Program Contacts (lNSYS Sales Representative, Additional lNSYS 

Attendees, ClS Monitor, INSYS Monitor) 

Program Location (venue name, street address, city, state) 

Program Type (Jn-Office, Venue-based, Marketing, Virtual, etc.) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

How long was the presentation (in minutes)? 

How long was the Q&A (in minutes)? 

Enter the total dollar amount from the duplicate receipt, obtained from the 

venue or food delivery company (excluding AV, room rental, parking) 

General Program Information 

Was PowerPoint presentation used the same as the approved slides noted 

during product training? 

If handouts were disseminated to the audience, were all the materials 

INSYS approved? Collect materials and note the lNSYS document 10 #in 

the Remarks section 

Was the presentation/exchange of information knowledge at a minimum 30 

minutes for in-office programs and 45 minutes for vendor programs? 

Category 1 • Feedback to Speaker/Safes Representative (if appropriate) 

Describe the transition between the disease state and product sections of 

the presentation 

All safety information was presented during the program (e.g., discussed at 

some point during presentation and/or attendees had enough time to read 

the safety slides)? If safety information was not presented in its entirety do 

not provide feedback and describe m category 4 

If paper slides were used for the presentation, were they collected at the 

conclusion of the program? 

Page 11of41 

Confidential 

INSYS Speaker Program Compliance Monitoring Report 

I 

ClS Monitor: Adam Toronto 

lNSYS Sales Representative: Ty Rustin 

Vietnam Restaurant 

710 N Waters Rd. 

Corpus Christi, TX 78401 

Venue-based 

Monday, November 4, 2013 - 8:40 PM 

SUBSYS® 

Advancements in the Treatment of Breakthrouah Pain in Cancer Patients fBTCP) 

DL Judson Some1V1lle, MD 

30 minutes 

4 minutes 

P•irthV ,,, 

Yes I No Remarks 

Yes The approved sti<:fe,'cteck was used for presentation purposes only. The Speaker did not 

~~ecifically sp~ak t~ _,e ~lides but mostly spoke about his own knowledge of the produ.c~ 

a~·w~.s- effective in fi{s-Oe!~very but hard to specify how far he veered off from the specific 

ctellve · llfthe a roved ct~Ck. 

N/A ~o~'.'~~~~(J~:S·~fe giv~n :o th~two office staff or attending HCP d~ring the presentation 

The knowledge was d1stnbuted verbally by the speaker to the audience 

N/A 

The HCP showed up· 1 hour and 40 minutes after the original start time and it appeared he 

rushed through the presentation so that all could eat and go as it was almost 9pm when 

the presentation started. 

Remarks 

The speaker rushed through specific slides with respect to the type of information that 

came from pharmakonetics and safety and copied non intolerance and hypersensitivity 

sections word for word from slides as the were uickl scanned over 

Severely lacking in content delivery in slides 6-13 Lacked the Adverse reactions in their 

entirety on page 11 

Paper slides were not used for the presentation. Only the approved deck electronically 

on an !Pad provided by the rep. The speaker read from the iPad and did not present it to 

the group, and the HCP at the table glanced occasionally over the shoulder of the 

speaker (round table) to see slides 

Confidential 

INS4289780 

INSYS_HSGAC_00007783 
Category 2 • Feedback to Speaker/Sales RepresentatiVe (if appropriate) 

If handouts were disseminated to the audience, were they distributed after 

completion of the disease awareness portion of the speaker program 

7 (explain how the handouts were disseminated)? 

Did the speaker (or sales rep if speaker is introduced) disclose that the 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Vation remains Category 2_ If 

signage/other materials or program setting indicates INSYS Therapeutics 

sponsorship, note the obse1Vation and provide feedback as Category 1 that 

8 this should be done orally 

Was there at least one attendee from an institution or office other than the 

9 speaker's? 

10a How many HCP attendees were at the event? 

10b How many speaker(s) were at the event? 

10c How many sales representatives were at the event? 

10d How many monitors were at the event? 

10e Total number of people at the event and took part 1n the meal 

Was a sales representative present during the entire presentation? (Note: 

this is not a requirement, however, it is good to note if the representative 

11 did not stay for the duration of the program) 

12a No more than two representatives were present at the program? 

12b Were there at least 3 RSVPs pnor to proceeding with the program? 

If two sales representatives were present atthe program, did the total 

13 RSVPs or attendees exceed 12 HCPs? 

If two sales representatives were present atthe program, did the second 

14 representative leave before the beginning of the presentation? 

If two sales representatives were present atthe program, and the second 

representative did not leave before the beginning of the presentation, was 

15 there prior approval? 

category 3 - Feedback to Speaker/Sales RepresentatNe (if appropriate) 

16 

If an offsite program, ~ere all participants who received a meal al59'f~esent 

for the entire infonnation presentation? 

17 

Was the event held in a private room away from the general publi6? ;~ .· l,, 

Did the sales representative require the attendees to sign into an 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s), 

speaker(s), INSYS employees). Note: Some offic~s refuse to allow 

their employees to sign in, and in those······ has to 

19 note the refusal to sign.,poes it matcl1 

List the number of attendees entered into the speaker program system 

{including the momtor{s), speaker{s), INSYS employees) Does it match 

20 the number on the siQn-in sheet(s)? 

!, 

Page 12 of 41 

Confidential 

Yes/No 

N/A 

No 

No 

Yes 

Yes 

Yes 

N/A 

N/A 

N/A 

Yes/No 

Yes 

No 

No 

Yes 

Yes 

INSYS Speaker Program Compliance Monitoring Report 

.I 

Remarks 

No signage stating that JN SYS was the sponsor of the program The obsel\1ation remains 

category 2 as it was all verbal 

Apart from C1S, and lNSYS rep, all attendees were from the speaker's office 

2 including the speaker 

1 

1 

1 

5 

Remarks 

The table where the presentation was given was within two (2) arms lengths of patrons 

also eating at the same restaurant 

Sign in sheet was filled out after dinner as the auditor asked the rep for a duplicate receipt 

and sign in sheet 

Access to system is not given to the monitors 

Confidential 

INS4289781 

INSYS_HSGAC_00007784 
Category 4 - No feedback to the Sales Representatives/Speakers by Monitor Yes/No Was a slide deck presented at the program? Yes 

21 

22 Did the speaker use only approved lNSYS Therapeutics slides, which Yes 

included the 1NSYS references/watermark? 1f no, comment in the Remarks 

section regarding specific slides added by the speaker 

23 Was at least some of the mandatory safety information presented during 

the presentation and/or did the attendees had ample time to read the 

safet slides? 

No 

24 Did the speaker limit the discussion to product or disease state information Yes 

that is consistent with the approved product indication? 

25 lfno, was the information given in response to an attendee's unsolicited N/A 

question? Document, with as much detail as possible, the question(s) and 

response(s) in section 36 

26 lfit was in response to an unsolicited question, did the speaker state that N/A 

the information was not part of the approved indication for the product and 

provide the medical liaison officer contact information? 

27 lfit was in response to an unsolicited question, did the speaker only 

respond to the question by providing the medical liaison officer contact 

information and return to the resentation? 

28 Describe any anecdotal information on the product that was shared with 

attendees, and how the speaker made it clear that these were his/her 

personal opinion or professional judgment, and did not represent lNSYS 

Thera eutics' osition. if off-label 

29 Describe any anecdotal information added by the sales representative 

Note: This excludes formulary and/or patient assistant program questions 

30 Describe any lavish or deluxe features at the venue. 

31 Was the program free from entertainment or recreation activities? 

32 Was the program free from gifts? If no, describe in detail the gifts that were 

d:stributed. 

33 Describe any direct comparisons that were made between the product and 

other product(s) 

34 Did the meal provided stay with the limit of the INSYS Therapeutics 

Compliance Policies 1$100/:al!end:1e dinm;r progran1. $20/.atte:nd:ae 

excluding AV, room rental, and parking? 

35 Enter the speakers honorarium. 

36a Fifi out a row below for each question asked by the attendees that did 

not appear consistent with the approved product indi.cations. 

NIA .. : 

. I 

I 

37a Based on the monitor'$ experience, describe areas where the~ 

representative exhibited behavior(s} that represent leading practices 

(e.g., particularly ~ngaging program, sale,s representative that 

seamlessly integrates compliance into their style, etc.)? 

Rep inteljeiMEid ,,on slide number 21 ~o ecn;e~~t ~e physicia'h 0111m incorrect 

dosage forlf'le example that was being given. .· 

·.· 

I 

38 Other Comments and Observations (e.g. duration of the program was 

not sufffcient, too much extra information added to the title slide) 

HCPs attending the program dicinot pay close attention to l!l'e 

presentation, speaker did not en~a'ge the participants but~~stJept 

repeating" you should read the insert, pu should read tht)'in$l'rl" 

The Speaker seemed to have a hafct, ·me"W:th slides 144~, di$cussing the 

efficacy of the drug during phase II an JI pain relieflfolh Subsys 

compared to the placebo. The Speaker most Of the time that 

the drug was only indicated for break thro P,ain "in aQUtt cancer 

patients" 

No specificity given as to how to titrate up and or down with the right type 

of prescription quantity. Speaker was very thorough in the opening of the 

product and destruction and application 

The event was originally scheduled at 7:00 PM but did not commence until 

8:40 PM due to a late arrival by a HCP 

Page 13 of 41 

Confidential 

N/A 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

See category 1 

other than a general approval o~ the product by the speakers' patients, no further opinions 

were shared by the speaker 

A direct comparison was made between the Fentanyl Lollipop or sucker and SU BSYS 

with respect to destruction of the product when finished. SUBSYS has prepackaged 

Speaker Response (document exactly how the question was handled by the 

speaker) 

f\!IP.. '··.····· ~ 

Based on the monitor's experience, describe areas where the seeaker exhibited 

behavlor(s) that represent leading practices (e.g., particulaily engaging speaker, 

speaker that seamlessly integrates complianoe into their atyle, etc.)? 

NIA 

Confidential 

INS4289782 

INSYS_HSGAC_00007785 
2 Checklist 

' -,_ 

Program Logistics 

Program Contacts (lNSYS Sales Representative, Additional lNSYS 

Attendees, ClS Monitor, INSYS Monitor) 

Program Location (venue name, street address, city, state) 

Program Type (Jn-Office, Venue-based, Marketing, Virtual, etc.) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

How long was the presentation (in minutes)? 

How long was the Q&A (in minutes)? 

Enter the total dollar amount from the duplicate receipt, obtained from the 

venue or food del!verv comoanv fexcludina AV room rental oarkmc) 

General Program Information 

Was powerpoint presentation used the same as the approved slides noted 

1 durino product trainino? 

If handouts were disseminated to the audience, were all the materials 

INSYS approved? Collect materials and note the 1NSYS document 10 #in 

2 the Remarks section 

Was the presentation/exhange of information knowledge at a minimum 30 

3 minutes for in-office nroarams and 45 minutes for vendor oroorams? 

Category 1 - Fe dbac to Spea er/Safe Representatlv (it appropriate) 

Describe the transition between the disease state and product sections of 

the resentation 

All safety information was presented during the program (e.g., discussed at 

some point during presentation and/or attendees had enough time to read 

the safety slides)? lf safety information was not presented in its entirety do 

not provide feedback and describe in category 4 

If paper slides were used for the presentation, were they collected at the 

conclusion of the ro ram? 

Page 14 of 41 

Confidential 

Yes/No 

Yes 

N/A 

No 

No 

N/A 

INSYS Speaker Program Compliance Monitoring Report 

CIS Monitor: Ryan Stewart 

lNSYS Sales Representative: Michelle Breitenbach 

Dr. Darshana Desai 

2177 Oaktree Road 

Edison, NJ 08820 

In-Office 

Thursdav, November 7, 2013 - 1 :00 PM 

SUBSYS® 

Advancements in the Treatment of Breakthrouqh Pain in Cancer Patients (BTCP) 

Dr. Manoi Patharkar, MD 

8 minutes 

1 mmute 

$139.72 

Remarks 

The presentation was displayed by the speaker via !Pad 

Rema~ 

The speaker provided a brief ove1View of the history of fentanyl, then provided SUBSYS 

No safety information was discussed. This was a very quick presentation describing what 

SUBSYS was and if the HCP would find it useful in her OB/GYN office. The speaker 

provided a brief background of history of Fentanyl, decribed how SUBSYS is used and its 

indications 

Paper slides were not used for the presentation Only the approved deck electronically 

on an iPad provided by the rep 

Confidential 

INS4289783 

INSYS_HSGAC_00007786 
Cateaotv 2 - Feedback to Saeaker/Sales Rearesentative fit 2~roarlatel 

If handouts were disseminated to the audience, were they distributed after 

completion of the disease awareness portion of the speaker program 

7 (exolain how the handouts were disseminated)? 

Did the speaker (or sales rep if speaker is introduced) disclose that the 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Vation remains Category 2_ If 

signage/other materials or program setting indicates INSYS Therapeutics 

sponsorship, note the obse1Vation and provide feedback as Category 1 that 

8 this should be done orallv. 

Was there at least one attendee from an institution or office other than the 

9 speaker's? 

10a How manv HCP attendees were at the event? 

10b How manv speakerfs) were at the event? 

10c How manv sales representatives were at the event? 

10d How many monitors were at the event? 

10e Total number of peor:le at the event and took part 1n the meal 

Was a sales representative present during the entire presentation? (Note: 

this is not a requirement, however, it is good to note if the representative 

11 did not stav for the duration of the Proaram) 

12a No more than two representatives were present at the proaram? 

12b Were there at least 3 RS\/Ps pnor to proceedino with the proqram? 

If two sales representatives were present atthe program, did the total 

13 RSVPs or attendees exceed 12 HCPs? 

If two sales representatives were present atthe program, did the second 

14 representative leave before the beoinnino of the presentation? 

If two sales representatives were present atthe program, and the second 

representative did not leave before the beginning of the presentation, was 

15 there prior aporoval? 

Catem "'3 - Feedback to Saeaker/Sales Rearesentative fit aaarooriateJ 

If an offsite program, were all participants who received a meal 

16 for the entire information presentation? ... 

17 Was the event held in a private room away from the Qeneral public? 

Did the sales representative require the attendees to sign into an 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s), 

sp~aker(s), INSYS ~mployees) .. Note: Some om.eels may refuse to allow 

their employees to ~1gn in, an~ 1n those r:::iQ.¢1..:t .,,. has to 

note the refusal to sign.pees it rnatct1 

19 I v I 

List the number of attendees entered into the speaker program system 

(including the monitor(s), speaker(s), INSYS employees). Does it match 

20 the number on the sign-in sheet(s)? 

Page 15 of 41 

Confidential 

Yes/No N/A 

No 

Yes 

Yes 

Yes 

Yes 

N/A 

N/A 

N/A 

Yes/No N/A 

Yes 

Yes 

No 

N/A 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

The Sales Representative introduced the speaker and informed the attendee that the 

speaker uses the INSYS product SUBSYS and that he will be providing further detail on 

the product. But there was no clear disclosure to the attendee that the program was 

sponsored by INSYS 

Dr. Darshana Desai 

1 

1 

2 

1 

9 (5 total individuals attended the actual speaker program. Per the checklist, a total of an 

additional 4 other office staff members took part in the meal.) 

The additional sales representative present was being trained by Michelle. 

The additional sales representative present was being trained by Michelle. 

The additional sales representative present was being trained by Michelle. 

>· I I 

Remarks 

I 

4 employees of the office (these employees did not attend the program) 

1 HCP 

2 INSYS Employees 

1 Speaker 

1 Monitor 

Access to system is not given to the monitors 

Confidential 

INS4289784 

INSYS_HSGAC_00007787 
Cate o 4 - No feedback to the Sales Re resentatives/S akers b Monitor Yes/No Was a slide deck presented at the program? Yes 

21 

22 Did the speaker use only approved lNSYS Tt1erapeutics slides, wt1ict1 Yes 

included the lNSYS references/watermark? lf no, comment in the Remarks 

section re ardin s ecific slides added b the s eaker. 

23 Was at least some of the mandatory safety information presented during 

the presentation and/or did the attendees had ample time to read the 

safety slides? 

No 

24 Did the speaker limit the discussion to product or disease state information Yes 

that is consistent with the a roved reduct indication? 

25 lfno, was the information given in response to an attendee's unsolicited N/A 

question? Document, with as much detail as possible, the question(s) and 

res onse s in section 36. 

26 If it was in response to an unsolicited question, did the speaker state that 

the information was not part of the approved indication for the product and 

provide the medical liason officer contact information? 

27 If it was in response to an unsolicited question, did the speaker only 

respond to the question by providing the medical liason officer contact 

information and return to the resentation? 

28 Describe any anecdotal information on the product that was shared with 

attendees, and how the speaker made it clear that these were his/her 

personal opinion or professional judgment, and did not represent 1NSYS 

Thera etics' osition. if off-label 

29 Describe any anecdotal information added by the sales representative. 

Note: This excludes formulary and/or patient assistant program questions 

30 Describe an lavish or deluxe features at the venue. 

31 Was the ro ram free from entertainment or recreation activities? 

32 Was the program free from gifts? lf no, describe in detail the gifts that were 

distributed. 

33 Describe any direct comparisons that were made between the product and 

other roduct(s . 

34 Did the meal provided stay with the limit of the INSYS Therapeutics 

Compliance Policies ($100/.atte,ndroe roinr1erpro,gram,$2J/atlenr1ee 

, excludin AV, room rental, and arkin ? 

35 Enter the s eakers honorarium. 

36a Fill out, a row below for each question asked by the attendees that did 

not annear consistent with the aooroved Product indications. 

The attend.ee asked if SUBSYS was only, used to~bfeal<lhrough pain in 

cancer patients. ···· ·. ···· ·1 

... I 

37a B;ilsed on the monitor's experience,, de-scribe areas where .the~ 

representatiVe exhibited behavior(s) that represent leading practices 

(e.g., particularly engaging program, sares representative that 

seamtesstv inteurates comtJliance Into their stv/e, etc.)? 

NIA '•A .I 

.. .... .. .... 

? 

,, 'I 

38 Other Comnients and Observatlon<;{e.g. (iuration of the program was 

not sufficient, too much extra information adrJed to the title slide) 

The duration of the prdg.r~,O:-~as not sufficient a.nd the· $.ffi}~ slides were 

not reviewed. The presentation was very short m time, butjhe attendee did 

also inform the speaker t~attqel df>:,not treat many cancE;!il' p~leints that 

have not already seen pain speCi.aJi~~ and that they would noi .. see 

themselves using this product on Caftf~~ P?ltients, as inqiea~~9·on the 

label 

NIA 

.· .... 

Page 16 of 41 

Confidential 

N/A 

N/A 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

Via iPad 

No safety information was discussed. This was a very quick presentation describing what 

SUBSYS was and if the HCP would find it useful in her OB/GYN office_ The speaker 

provided a brief background of history of Fentanyl, decribed how SUBSYS is used and its 

indications 

None 

None 

None 

None 

Total of$139.10'divided by the total number of people that attended the program comes 

out to a tM!af of $27.94 per person. 

Speaker Response (cJocument exactly how the question was handled by the 

soeaker1 

!fl':l!e~kef informed the attendee that yes, this is only to be used for breakthrough pain 

in ¢anc'erQ;;ftients . 

. ;.. I 

Based on the monitor's experience, describe areas where the speaker exhibited 

behavlor(s) that represent leading practices (e.g., particularly engaging speaker, 

speaker that seamlessly Integrates compliance into their style, etc.)? 

NIA 

Confidential 

INS4289785 

INSYS_HSGAC_00007788 
Program Logistics 

Program Contacts (lNSYS Sales Representative, Additional lNSYS 

Attendees, ClS Monitor, INSYS Monitor) 

Program Location (venue name, street address, city, state) 

Program Type (Jn-Office, Venue-based, Marketing, Virtual, etc.) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

How long was the presentation (in minutes)? 

How long was the Q&A (in minutes)? 

Enter the total dollar amount from the duplicate receipt, obtained from the 

venue or food deliverv comoanv fexcludina AV, room rental, oarkino) 

General Program Information 

Was powerpoint presentation used the same as the approved slides noted 

1 durinq oroduct traininq? 

If handouts were disseminated to the audience, were all the materials 

INSYS approved? Collect materials and note the lNSYS document 10 #in 

2 the Remarks section 

Was the presentation/exhange of information knowledge at a minimum 30 

3 minutes for in-office proQrams and 45 minutes for vendor proQrams? 

Category 1 - Feedback to Speaker/Sales Representative (if appropriate) 

Describe the transition between the disease state and product sections of 

the presentation 

All safety information was presented during the program (e.g , discussed at 

some point during presentation and/or attendees had enough time to read 

the safety slides)? If safety information was not presented in its entirety do 

not provide feedback and describe in category 4 

Yes/No 

Yes 

Yes 

No 

Yes 

lf paper slides were used for the presentation, were they collected at the N/A 

conclusion of the program? 

Category 2 - Feedback to Speaker/Safes Representative (if appropriate) 

If handouts were disseminated to the audience, were they distributed after 

completion of the disease awareness portion of the speaker program 

(explain how the handouts were disseminated)? 

Did the speaker (or sales rep if speaker is introduced) disclose that the 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Vation remains Category 2_ If 

signage/other materials or program setting indicates INSYS Therapeutics 

sponsorship, note the obse1Vation and provide feedback as Category 1 that 

this should be done orally 

Was there at least one attendee from an institution or office other than the 

speaker's? 

10a How many HCP attendees were atthe event? 

1 Ob How many speaker{s) were at the event? 

1 Oc How many sales representatives were at the event? 

1 Od How many monitors were at the event? 

1 Oe Total number of people at the event and took part in the meal 

Was a sales representative present during the entire presentation? (Note: 

this is not a requirement, however, it is good to note if the representative 

11 did not stay for the duration of the program) 

12a No more than two representatives were present at the program? 

12b Were there at least 3 RSVPs pnor to proceeding with the program? 

If two sales representatives were present atthe program, did the total 

13 RSVPs or attendees exceed 12 HCPs? 

If two sales representatives were present atthe program, did the second 

14 representative leave before the beginning of the presentation? 

If two sales representatives were present at the program, and the second 

representative did not leave before the beginning of the presentation, was 

15 there prior approval? 

Page 17 of 41 

Confidential 

Yes/No 

Yes 

No 

Yes 

Yes 

Yes 

Yes 

N/A 

N/A 

N/A 

INSYS Speaker Program Compliance Monitoring Report 

ClS Monitor: Adam Toronto 

lNSYS Sales Representative· Kristiana Wright 

Rock Oncology Specialists 

910 W 5th Ave #700 

Sookane WA, 99204 

In-Office 

Tuesday, November 19, 2013 - 11:30 AM 

SUBSYS® 

Advancements in the Treatment of Breakthrouah Pain in Cancer Patients (BTCP) 

Dr. Jolin Hatl1ewav, MD 

6 minutes - 9 minutes; 

Three HCPs passed through while monitor was present 1, 6 minutes, 2, 1 O minutes, 3, 9 

minutes. Speaker was present for about 2 hours with an expectation of 5 HCPs to hear 

the oresentation 

No Q&A as it was a quick in and out lunch program so HCPs asked questions as they 

had them and included in the total time amount 

Pai°,'.~j>rnt by fNS'(l!; corporate 

Remarks 

Very difficult as HCP's passed in and have 5-10 minutes to listen 

Remarks 

Again, being that the HCPs had very little time, the speaker did a good job to summarize 

the slides and specific safety, titration, and usage information within a very short period of 

time 

Speaker was certain to review all safety information with the minimal time for each HCP 

as they passed through 

Remarks 

Handouts for the discount cards/PaP programs as well as the REMS(TIRF) enrollment 

were provided to each HCP by the rep 

6 (Monitor left after 1.5 hours and three HCP presentations - possible that others came) 

N/A 

N/A 

N/A 

Confidential 

INS4289786 

INSYS_HSGAC_00007789 
Category 3 - Feedback to Speaker/Sales Representative {If appropriate) Yes/No 

If an offsite program, were all participants who received a meal also present N/A 

16 for the entire information oresentation? 

17 Was the event held in a orivate room awav from the aeneral oublic? Yes 

Did the sales representative require the attendees to sign into an Yes 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s), N/A 

speaker(s), INSYS employees). Note: Some offices may refuse to allow 

their employees to sign in, and in those cases the representative has to 

19 note the refusal to sign .. Does it match the number obse1Ved? 

List the number of attendees entered into the speaker program system N/A 

(including the monitor(s), speaker(s), INSYS employees). Does it match 

20 the number on the siQn-in sheetts)? 

Yes/No Yes 

21 

22 Did the speaker use only approved lNSYS Therapeutics slides, which Yes 

included the 1NSYS references/watermark? If no, comment in the Remarks 

section re ard!n s ecific slides added b the s eaker 

23 Was at least some of the mandatory safety information presented during Yes 

the presentation and/or did the attendees had ample time to read the 

safety slides? 

24 Did tl1e speaker limit tfle discussion to product or disease state information Yes 

that is consistent with the approved product indication? 

25 lfno, was the information given in response to an attendee's unsolicited N/A 

question? Document, with as much detail as poss:ble, the question(s) and 

response(s) in section 36. 

26 If it was in response to an unsolicited question, did the speaker state that N/A 

the information was not part of the approved indication for the product and 

provide the medical liason officer contact information? 

27 If it was in response to an unsolicited question, did the speaker only 

respond to the question by providing the medical liason officer contaFt 

28 

information and return to the resentation? 

Describe any anecdotal information on :he product that was sha.re;d fith. 

attendees, and how the speaker made it clear that these were his/h~r " 

personal opinion or professional judgment, and did not represent 1NSYS 

Therapetics' position. (if off-label) 

29 Describe any anecdotal information added by the sales representative. 

Note: This excludes formulary and/or patient assistant program questions-. 

30 Describe an lavish or deluxe features at the venue 

31 Was the program free from entertainment or recreation activities? 

32 Was the program free from gifts? lf no, describe in detail the gifts that were 

distributed 

33 Describe any direct comparisons that were .. \Jlade between the'Pf9dUCt and 

other product(s ). 

room rental, and parking? 

35 Enterthe 

36a Fill out a row below for each question asked by the attendees that did 

not aooear consistent With the approved product Indications. 

NIA .•. 

··· ... I 

. ··········· 

37a Based on the monitor's experience, describe areas where the lii1lM.. 

representative exhjbited behavior(s} that represent leading practices 

{e.g., particularly engaging program, sales representative that 

seamlessly Integrates compliance into their style, etc.}? 

Sales rep was very knowlegable in productinflcrmaitll!l a!l<lactually 

corrected speaker on more than one occasiO\hWit'°',,re~p~d to usage and 

destruction to ensure the most accurate infomlatton Was oresented 

38 Other Comments and Ol;>servations(e"g. duration of flJe program was 

not sufficient tao much extra information added to the tftle slil:lel 

Both Rep and Speaker did well with a small venue and HCPs that were 

rushed throuQh a small break room 

Page 18 of 41 

Confidential 

N/A 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

Onsite presentation - N/A 

Lunch Room in office 

Review with 1NSYS Corporate 

Access to system is not given to the monitors 

Remarks 

Speaker Response (document exactly how the question was handled by the 

speaker) 

N/A 

Based on the monitor's experience, describe areas where the ~exhibited 

behavior(s) that represent leading practices (e.g., particularly engaging speaker, 

speaker that seamlessly Integrates compliance into their style, etr:J? 

Speaker was very able to present the benefits of the product and how it has vastly 

changed the lifes of his patients Made good comparisons between competing products 

and SUBSYS 

Confidential 

INS4289787 

I NSYS _HSGAC _ 00007790 
Checklist 

Program Logistics 

Program Contacts (INSYS Sales Representative, Additional INSYS 

Attendees, CIS Monitor, INSYS Monitor) 

Program Location (venue name, street address, city, state) 

Program Type (In-Office, Venue-based, Marketing, Virtual, etc.) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

How long was the presentation (in minutes)? 

How long was the Q&A (in minutes)? 

Enter the total dollar amount from the duplicate receipt, obtained from the 

venue or food deliverv comoanv (excludina AV, room rental, oarkino) 

General Program Information 

Was PowerPoint presentation used the same as the approved slides noted 

during product training? 

1 

If handouts were disseminated to the audience, were all the materials 

INSYS approved? Collect materials and note the 1NSYS document 10 #in 

2 the Remarks section 

Was the presentation/exchange of information knowledge at a minimum 30 

3 minutes for in-office oroarams and 45 minutes for vendor orocrams? 

.· " 

category 1 • Feedback to Speaker/Sa/es Representative (if appropriate) 

Describe the transition between the disease state and product sections of 

the presentation. 

All safety information was presented during the program (e.g., discussed at 

some pomt dunng presentation and/or attendees had enough time to read 

the safety slides)? If safety information was not presented in its entirety do 

not provide feedback and describe m category 4 

If paper slides were used for the presentation, were they collected atthe 

conclusion of the program? 

Page 19 of 41 

Confidential 

Yes/No 

N/A 

N/A 

No 

N/A 

N/A 

INSYS Speaker Program Compliance Monitoring Report 

C1S Monitor: Eugene Shvartsman 

lNSYS Sales Representative· Ben Ecker 

Devon 

225 S 18th Street 

Philadelphia, PA 19103 

Venue-based 

Tuesdav, November26, 2013 - 5:23 PM 

SUBSYS® 

Advancements in the Treatment of Breakthrough Pain in Cancer Patients (BTCP) 

Dr Rishin Patel, MD 

20 - 30 minutes; 

Per discussion with the sales representative and the speaker, ClS noted the presentation 

was approximately 20 -30 minutes.ClS noted the program was originally scheduled at 

7:00 PM, but was re-scheduled to an earlier time due to weather conditions. Per review of 

the copy of the receipt, CIS noted the program commenced at 5:23 PM. CIS was notified 

of this change at 5:20 PM and did not arrive at the venue until 6:15 PM therefore, ClS was 

not present for the presentation 

10 minutes; 

Per discussion with the sales preventative and the speaker, CIS noted the Q&A was 

approximately 10 minutes. As noted above, the program was originally scheduled at 7:00 

PM, but was re-scheduled to an earlier time due to weather conditions. Per review of the 

copy of the receipt, ClS noted the program commenced at 5:23 PM. C1S was notified of 

this change at 5:20 PM and did not arrive at the venue until 6:15 PM therefore, ClS was 

not oresent for Q&A. 

$382.09 

Remarks 

Aliho~gfjZnot present forf!l!lpmsentation, CIS reviewed a copy of the slides within the 

iPi\ro and noh;H!f',,U1ere were ftP' inconsistencies between tile presentation and the approved 

sfides. .... 

ClS noted an invitation to the speaker program was disseminated to the audience prior to 

the event ClS noted that no other materials were given out during the event and the 

proQram was presented via iPad 

Remarks 

ClS was not present during the presentation. 

ClS was not present during the presentation 

ClS was not present during the presentation. As noted above, ClS reviewed a copy of the 

slides within the !Pad and noted there were no inconsistencies between the presentation 

and the approved slides 

Confidential 

INS4289788 

INSYS_HSGAC_00007791 
INSYS Speaker Program Compliance Monitoring Report 

Cateaorv 2. Feedback to StJeaker/Sales Reoresentatlve (If aDDfOIJrfatel Yes/No Remarks 

If handouts were disseminated to the audience, were they distributed after N/A ClS was not present during the presentation 

completion of the disease awareness portion of the speaker program 

7 fexolain how the handouts were disseminated)? 

Did the speaker (or sales rep if speaker is introduced) disclose that the N/A ClS was not present during the presentation 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Vation remains Category 2_ If 

signage/other materials or program setting indicates INSYS Therapeutics 

sponsorship, note the obse1Vation and provide feedback as Category 1 that 

8 this should be done orallv 

Was there at least one attendee from an institution or office other than the Yes 

9 speaker's? 

10a How many HCP attendees were at the event? 3 

10b How manv soeakeri's) were at the event? 1 

10c How manv sales representatives were at the event? 1 

10d How manv monitors were at the event? 1 

10e Total number of peoi:le at the event and took part 1n the meal 6 

Was a sales representative present during the entire presentation? (Note: Yes 

this is not a requirement, however, it is good to note if the representative 

11 did not stav for the duration of the oroaram) 

12a No more than two representatives were present at the proQram? Yes 

12b Were there at least 3 RSVPs onor to nroceedina with the oroaram? Yes 

If two sales representatives were present atthe program, did the total N/A 

13 RSVPs or attendees exceed 12 HCPs? 

If two sales representatives were present atthe program, did the second N/A 

14 reoresentative leave before the beainnina of the oresentation? 

If two sales representatives were present atthe program, and the second N/A 

representative did not leave before the beginning of the presentation, was 

15 there prior approval? 

·········· .. 

Category 3 - Feedback to Speaker/Sates Representative (if appropriate) Yes/No Remarks 

If an offsit~ p~ogram, ~ere all participants who received a meal al sq r~~~nt Yes 

16 for the entire information presentation? I 

17 Was the event held in a orivate room awav from the aeneral oublic? Yes The sneaker oroaram was held in a orivate corner of a restaurant 

Did the sales representative require the attendees to sign into an .· Yes 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s)t Yes 1 Speaker 

speaker(s). INSYS employees). Note: Some offices may refuse to allow .• 3 HCP (2 MDs and 1 PA) 

their employees to sign in, and in those cases thE1 representative has to 1 Sales Representative 

note the refusal to sign.poes it match the n¥~b~f·obS$1l~ed? 

ClS noted the sales representative pnnted name was included on the sign-in sheet but no 

19 I '\ signature was present. 

List the number of attendees entered into the speaker program system N/A ',i\:tcess to syste'ITT tSt16t given to the monitors 

(including the monitor(s), speaker(s), INSYS employees). Does it match 

20 the number on the sian-m sheet(s)? 

:, 

Page 20 of 41 Confidential 

Confidential INS4289789 

I NSYS _HSGAC _ 00007792 
Cate o 4 - No feedback to the Sale$ Re resentativ1'$/S akers b Monitor 

Was a slide deck presented at the program? 

21 

22 Did the speaker use only approved INSYS Therapeutics slides, which 

included the 1NSYS references/watermark? If no, comment in the Remarks 

section re ardin s ecific slides added b the s eaker. 

23 Was at least some of the mandatory safety information presented during 

the presentation and/or did the attendees had ample time to read the 

safe slides? 

24 Did the speaker limit the discussion to product or disease state information 

that is consistent with the a roved reduct indication? 

25 If no, was the information given in response to an attendee's unsolicited 

question? Document, with as much detail as possible, the question(s) and 

response(s) in section 36. 

26 If it was in response to an unsolicited question, did the speaker state that 

the information was not part of the approved indication for the product and 

rovide the medical liaison officer contact information? 

27 If it was in response to an unsolicited question, did the speaker only 

respond to the question by providing the medical liaison officer contact 

information and return to the resentation? 

28 Describe any anecdotal information on the product that was shared with 

attendees, and how the speaker made it clear that these were his/her 

personal opinion or professional judgment, and did not represent 1NSYS 

Thera eutics' osition. ifoff-label 

29 Describe any anecdotal information added by the sales representative. 

Note: This excludes formulary and/or patient assistant program questions 

30 Describe an lavish or deluxe features at the venue. 

31 Was the ro ram free from entertainment or recreation activities? 

32 Was the program free from gifts? lf no, describe in detail the gifts that were 

distributed 

33 Describe any direct comparisons that were made betw"een the p~o<¥15.~ .. ~~d 

other roduct(s . 

34 Did the meal provided stay with the limit of the INSYS Therapeutics 

Compliance Policies ($10:J/,at!e1ndcJe coinr1erprogrn1m,$28/atl.encJee 

program). excluding AV, room rental, and parking? 

35 Enter the s eakers honorarium. 

36a Fifi out a row below tor each question asked by the attendees that did 

not annear consistent with the aooroved product inciications. 

NIA ' ,,,, 

,', 

,,, 

37a Based on the monitor's experiencei. describe areas where the safes 

representative exhibited behavior(s} that repr1'$ent leading practices 

(e.g., particularly engaging program, sales representative that 

seamlessly intearates compliance into their style, etc.I? 

NIA I 

I,,,,, ~' ', 

I 

38 Other Comments and Observations( e.g. duration of t{Je program was 

not sufficient, too much extra information added to the title s/kie) 

NIA 

"' 

Page 21of41 

Confidential 

Yes/No 

N/A 

N/A 

N/A 

N/A 

N/A 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

ClS was not present during the presentation. Per discussion with the sales representative 

and the speaker, the slides were presented via iPad. 

Although not present for the presentation, C1S reviewed a copy of the slides and noted 

there were no incons1stenc1es between the presentation and the approved slides 

ClS was not present during the presentation. Per discussion with speaker, ClS noted he 

did not review all the slides within the presentation. 

ClS was not present during the presentation and Q&A 

ClS was not present during the presentation and Q&A 

ClS was not presen;~ r~:ing the presentation and Q&A 

ClS was notpr,ese_nfduring the presentation and Q&A 

CIS ll'/as"not present d!lting the presentation and Q&A 

CIS was not present during the presentation and Q&A 

None 

ClSc~iis p,<Jfpresent during the presentation and 

Speaker Response (document exactly how the question was handled by the 

soeakerJ 

i\llA, .. 

1 

Based on the monitor's experience, describe areas where the speaker exhibited 

behavior(s) that repr1'$ent leading practices (e.g., particularly engaging speaker, 

speaker that seamlessly integrate$ compliance into their style, etcJ? 

NIA 

Confidential 

INS4289790 

I NSYS _HSGAC _ 00007793 
INSYS Speaker Program Compliance Monitoring Report 

Checklist 

Progra;m Logistics 

Program Contacts (INSYS Sales Representative, Additional INSYS CIS Monitor: Eugene Shvartsman 

Attendees, ClS Monitor, INSYS Monitor) JN SYS Sales Representative· Dan Tondre 

lNSYS Area Business Liaison: Asqa Nawaz 

Program Location (venue name, street address, city, state) Ruth's Chris 

6700 S Tamiami Trail 

Sarasota, FL 34231 

Program Type (In-Office, Venue-based, Marketing, Virtual, etc.) Venue-based 

Program Date & Start Time Monday, December 2, 2013 - 7:30 PM 

Brand SUBSYS® 

Presentation Title Advancements in the Treatment of Breakthrough Pain in Cancer Patients (BTCP) 

Speaker(s) Dr. Dwight Fitch, MD 

How long was the presentation (in minutes)? 32 minutes 

How long was the Q&A (in minutes)? 6 minutes 

Enter the total dollar amount from the duplicate receipt, obtained from the $700.-0<>; I 

venue or food delivery company (excluding AV, room rental, parking) ~ 

It is undtear which linedternwithin the receipt is related to a room rental. 

General Program Information Yes!No Remarks 

Was PowerPoint presentation used the same as the approved slides noted Yes 

1 during product training? 

If handouts were disseminated to the audience, were all the materials Yes A hard copy of the presentation was provided to all attendees. C1S noted that slide 7 

INSYS approved? Collect materials and note the 1NSYS document 10 #in (Indications and Usage) and slide 10 (Important Safety Information) were not legible. The 

2 the Remarks section illeaibilitv appears to have been caused bv a printina error 

Was the presentation/exchange of information knowledge at a minimum 30 No 

3 minutes for in-office programs and 45 minutes for vendor programs? .. 

Category 1 - Feedback to Speaker/Sales Representative (if appropriate) ::liil Remarks 

Describe the !ransition between the disease state and product sections of The ~~e~ker provided a bnef overview of the history of fentanyl, then provided SU BSYS 

4 the nresentat!on snec1f1c information 

All safety information was presented during the program (e.g., discussed at 

some point during presentation and/or attendees had enough time to read 

the safety slides)? lf safety infonnation was not presented in its entirety do 

not provide feedback and describe in category 4 

5 

lf paper slides were used for the presentation, were they collected at the 

6 conclusion of the proqram? 

Cateaorv 2 - Feedba~k to soeaker/sales Reoresentative {if annrooriateJ 

If handouts were disseminated to the audience, were they distributed after 

completion of the disease awareness portion of the speaker program 

7 fexolain how the handouts were disseminated)? 

Did the speaker (or sales rep if speaker is introduced) disclose that the 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Vation remains Category 2. If 

signage/other materials or program setting indicates INSYS Therapeutics 

sponsorship, note the obse1Vation and provide feedback as Category 1 that 

8 this should be done orallv. 

Was there at least one attendee from an institution or office other than the 

9 speaker's? 

10a How manv HCP attendees were at the event? 

10b How manv soeaker(s) were at the event? 

10c How manv sales reoresentatives were at the event? 

10d How manv monitors were at the event? 

10e Total number of oeor:le at the event and took nart in the meal 

Was a sales representative present during the entire presentation? (Note: 

this is not a requirement, however, it is good to note if the representative 

11 did not stav for the duration of the nronraml 

12a No more than two reoresentatives were oresent at the oroaram? 

12b Were there at least 3 RS\/Ps orior to oroceedina with the oroaram? 

If two sales representatives were present atthe program, did the total 

13 RSVPs or attendees exceed 12 HCPs? 

If two sales representatives were present atthe program, did the second 

14 reoresentative leave before the beainnina of the nresentation? 

If two sales representatives were present at the program, and the second 

representative did not leave before the beginning of the presentation, was 

15 there orior aooroval? 

Page 22 of 41 

Confidential 

No 

No 

.· > 

Yes/No N/A 

No 

No 

Yes 

Yes 

Yes 

As noted above slide 10 (Important Safety lnfonmation) was not legible within the 

handouts provided to the attendees 

Minimal amount of time was on spent on safety information. The speaker primarily 

focused on accidental exposure and that SUSBYS is only available through TIRF REMS. 

The speaker also noted that he was not aware of any incidents that have resulted in death 

for patients that have utilized SUBSYS. This statement was confirmed by Aqsa Nawa, 

Area Business Liaison. The speaker also noted that due to the fact that SUBSYS 

contains alcohol; it prevents patients from spraying the drug into their nose or eyes 

Remarks 

No handouts were disseminated after the disease state portion 

There was no clear disclosure to the attendees thatthe program was sponsored by 

INSYS. The Sales Representative introduced the speaker and informed the attendees tha 

the speaker will provide details regarding SUBSYS 

All the attendees including the speaker were affiliated with the same practice 

3 

1 

2 (1 sales representative and 1 area business liaison) 

1 

7 

Not applicable, there was only 1 sales representative and 1 area business liaison 

Not applicable, there was only 1 sales representative and 1 area business liaison 

Not applicable, there was only 1 sales representative and 1 area business liaison 

Confidential 

INS4289791 

INSYS_HSGAC_00007794 
Category 3 - FeedbaQk to Speaker/Sales Representative (ff appropriate) Yes/No 

If an offsite program, were all participants who received a meal also present Yes 

16 for the entire infonnation presentation? 

17 Was the event held in a private room away from the general public? Yes 

Did the sales representative require the attendees to sign into an Yes 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s), No 

speaker(s), 1NSYS employees). Note: Some offices may refuse to allow 

their employees to sign in, and in those cases the representative has to 

note the refusal to sign.pees it match the number observed? 

19 

List the number of attendees entered into the speaker program system N/A 

(including the monitor(s), speaker(s), INSYS employees), Does it match 

20 the number on the sign-in sheet(s)? 

Category 4 - No feedback to the Sales Representatives/Speakers by Monitor Yes/No Was a slide deck presented at the program? Yes 

21 

22 Did the speaker use only approved lNSYS Therapeutics slides, which Yes 

included the 1NSYS references/watermark? lf no, comment in the Remarks 

section re ardin s ecific slides added b the s eaker. 

23 Was at least some of the mandatory safety information presented during 

the presentation and/or did the attendees had ample time to read the 

safe slides? 

No 

24 Did the speaker limit the discussion to product or disease state information Yes 

that is consistent with the approved product indication? 

25 If no, was the information given in response to an attendee's unsolicited 

question? Document, with as much detail as possible, the question(s) and 

response(s) in section 36. 

26 If it was in response to an unsolicited question, did the speaker stat~ that 

the information v:ias not part of the approv~d indic~tion for the pro®Tt, and 

provide the medical liaison officer contact information? 1 

27 If it was in response to an unsolicited question, did the speaker ont'2 ; 

respond to the question by providing the medical liaison officer contad 

information and return to the presentation? 

28 Describe any anecdotal information on the product that was shared with 

attendees, and how the speaker made it clear that these were his/her 

personal opirnon or professional judgment, and dicl not represent 1NSYS 

Therapeutics' position, (if off-label) 

29 Describe, any anecdotal information added lly the ,sales repreilli!)_~~ve: 

Note: This excludes formulary and/or patietJ~ ~ss1stant program questions 

30 Describe an lavish or deluxe features at the venue. 

31 Was the program free from entertainment or recreation activities? 

32 Was the program free from gifts? If no, describe in detail the gifts that were 

distributed, 

33 Describe SriY''(f.trect comparisons that were 'triilde betvveen tna:f)toduct and 

other prot!ucf{sj, 

34 Did the meal provided stay with the limit of the INSYS Therapeutics 

Compliance Policies ($100/atlc,11d<oe cli1111e1 

lb1E1akl'astlluncl1 program). excluding AV, room rental, and parking? 

35 Enter the speakers honorarium 

Page 23 of 41 

Confidential 

N/A 

N/A 

N/A 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

1 Speaker 

3 HCP 

1 Monitor (CIS) 

1 Sales Representative 

The Area Business L:aison did not sign the sign-in sheet 

Access to system is not given to the monitors. 

Remarks 

A hard copy of the presentation was disbursed prior to the commencement of the 

presentation. As noted above, C1S noted that slide 7 (Indications and Usage) and slide 10 

(Important Safety Information) were not legible. The illegibility appears to have been 

caused by a printing error 

The speaker noted the attendees were knowledgeable about the safety information based 

on their professional experience with Fentanyl 

N/A 

N/A 

N/A 

The speaker staled lfiathe had a patient that complained about back pain and that the 

,P~~i~nt acknowledgedJhat ~~ey have been presc.ribed several drugs on the market but 

none oftbem were effectiv~. The speaker prescribed the patient SUBSYS and noted that 

-~as on!Y1f!\~dication that Wrirl<ed for the patient 

'Cl$ noted it wa~ ~~~~.ar if the patient was a cancer patient 

None 

None 

The sales representative and the speaker compared SUBSYS with Act1q. They noted that 

SUBSYS is disposed after it has been used therefore, it's easier to keep out of reach of 

children. They further noted that Actiq, is a lollipop that can be accidently picked up by a 

non intended user if the intended individual did not use the full dosage of the product 

ClS noted there were 6 individuals that were drinking wine and at least each person had 

two seivi11gs but, only 7 glasses were ct1arged to tl1e bill. Furthermore, the speaker t1ad 

an alcoholic beverage that was not wine which was not included within the bill. Therefore, 

it is unclear why the receipt did not include these items 

Confidential 

INS4289792 

I NSYS _HSGAC _ 00007795 
36a Fill out a row below for each question asked by the attendees that did 

not annt:1.ar consistent with the aDDroved oroduct indications. 

37a Based on the monitor'$ experience, describe areas where the §iJ.f§§.. 

rgpresentative exhibited behavlor(s) that represent leading practices 

(e.g,,1 p?rticu/arly engaging program, sales representative that 

seamlesslv l!>tearates comoliance into their stvle, etcJ? 

38 Other Comments and Observatlona (e.g_ duration of the program was 

not sufficient, too much extra information added to the title slide) 

The speaker did not discuss the majority of the slides in detail 

An attendee inquired if patients complained about any burning when taking 

the product due to dehydrated alcohol. The speaker noted he was not 

aware of any situations 

An attendee inquired if insurance companies cover SUBSYS. The Sales 

Representative and Area Business Liaison stated that it depends on the 

patient's insurance. They noted that majority of the insurance companies 

will cover the medication. The Area Business Liaison noted there have 

been instances where lNYSIS has paid for patient's co-pays or provided 

them coupons. 

An attendee inquired if all pharmacies stock SUBSYS. The sales 

representative noted lNYSIS supplies their product to a niche community o 

pharmacies. The sales preventative further noted not all pharmacies stock 

this product, but it can be delivered to the patient within 1 business day to 

their house 

Page 24 of 41 

Confidential 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Speaker Response (document exactly how the question was handled by the 

soeakerJ 

Based on the monitor~s experience, describe ar~aff where the sneaker exhibited 

behavloi(s) that represent leading practices (e.g., particularly engaging speaker, 

speaker that seamlessly integrates compliance into their style, etcJ? 

Confidential 

INS4289793 

INSYS_HSGAC_00007796 
Checklist 

Program Logistics 

Program Contacts (lNSYS Sales Representative, Additional 1NSYS 

Attendees, ClS Monitor, INSYS Monitor) 

Program Location (venue name, street address, city, state) 

Program Type (In-Office, Venue-based, Marketing, Virtual, etc.) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

How long was the presentation (in minutes)? 

How long was the Q&A (in minutes)? 

Enter the total dollar amount from the duplicate receipt, obtained from the 

venue or food delivery company (excludinQ AV, room rental, parkinQ) 

General Program Information 

Was PowerPoint presentation used the same as the approved slides noted 

1 durina oroduct trainina? 

If t1andouts were disseminated to tt1e audience, were all the matelials 

INSYS approved? Collect materials and note the INSYS document 10 #in 

2 the Remarks section 

Was the presentation/exchange of information knowledge at a minimum 30 

3 minutes for in-office proqrams and 45 minutes for vendor proorams? 

categofjl • Feedback to Speaker/Sales Represe at/ve (if appropriate) 

Describe the transition between the disease state and product sections of 

the resentation. 

All safety information was presented during the program (e.g., discussed at 

some point during presentation and/or attendees had enough time to read 

the safety slides)? If safety information was not presented in its entirety do 

not provide feedback and describe m category 4 

lf paper slides were used for the presentation, were they collected at the 

conclusion of the ro ram? 

Cate o 2 - Feedback to s eaker!Sales Re resentative If ro riate 

If handouts were disseminated to the audience, were they distributed after 

completion of the disease awareness portion of the speaker program 

ex lain how the handouts were disseminated ? 

Did the speaker (or sales rep if speaker is introduced) disclose that the 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Vation remains Category 2. If 

signage/other materials or program setting indicates INSYS Therapeutics 

sponsorship, note the obse1Vation and provide feedback as Category 1 that 

this should be done orall 

Yes/No 

Yes 

Yes 

No 

·· .... 

Yes 

N/A 

Yes/No N/A 

No 

Was a sales representative present during the entire presentation? (Note: Yes 

this is not a requirement, however, lt is good to note if the representative 

11 did not sta for the duration of the ro ram 

12a No 

12b No 

If two sales representatives were present atthe program, did the total No 

13 RSVPs or attendees exceed 12 HCPs? 

If two sales representatives were present atthe program, did the second No 

14 re resentative leave before the be innin of the resentation? 

If two sales representatives were present at the program, and the second 

representative did not leave before the beginning of the presentation, was 

15 there rior a roval? 

Page 25 of 41 

Confidential 

Yes 

INSYS Speaker Program Compliance Monitoring Report 

'•< 

ClS Monitor: Adam Toronto 

lNSYS Sales Representative· Fernando Serrano 

JN SYS District Manager: Jonathon Roper 

Other: John Grummer, Divya Agrawahl, Rachel Ortense 

Sojourn 

233 E 79th Street 

Manhattan, NY 

Venue-based 

Fridav. December j 3 2013 - 7:35 PM 

SUBSYS® 

Advancements in the Treatment of BreakthrouQh Pain in Cancer Patients (BTCP) 

Dr. Romanth Wahmahrae MD 

33 minutes 

N/A; 

No specific Q&A but questions were asked durinQ the presentation. 

P~id by INSYS Corporate "· 

Remarks 

,\ 

presented to thE! .HCfs present and wt1en asked by the 

~~~:~;~~ .. representative stated that 11~ .had already passed out the 

a .. 

Remarks 

The speaker did a very thorough Job at transition from section to section Disease state 

to actual reduct, use, and titration was well aeflned. 

Paper slides were not used for the presentation. Only the approved deck electronically 

on an iPad provided by the rep. 

Remarks 

No handouts were disseminated after the disease state portion 

2 re s/ 1 District Mana er 

Accordin to the 1NSYS sales re resentative there were onl two 

Second sales representative is new and was shadowing for educational purposes 

Confidential 

INS4289794 

INSYS_HSGAC_00007797 
Cateaorv 3-Feedback to Saealier!Sales Rearesentative flf 2nnroorlatel Yes/No If an offsite program, were all participants who received a meal also present No 

for the entire information presentation? 

16 

Was the event held in a private room away from the general public? No 

17 

Did the sales representative require the attendees to sign into an Yes 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s), Yes 

speaker(s), INSYS employees). Note: Some offices may refuse to allow 

their employees to sign in, and in those cases the representative has to 

19 note the refusal to sign.pees it match the number observed? 

List the number of attendees entered into the speaker program system N/A 

(including the monitor(s), speaker(s), INSYS employees) Does it match 

20 the number on the sian-in sheet(s)? 

Yes/No Was a slide deck presented at the program? Yes 

21 

22 Did the speaker use only approved lNSYS Therapeutics slides, which Yes 

included the 1NSYS references/watermark? lf no, comment in the Remarks 

section re ardin s ecific slides added b the s eaker. 

23 Was at least some of the mandatory safety information presented during Yes 

tl1e presentation and/or did the attendees t1ad ample time to read the 

safe slides? 

24 Did the speaker limit the discussion to product or disease state information 

that is consistent with the a roved reduct indication? 

Yes 

25 lfno, was the information given in response to an attendee's unsolicited N/A 

question? Document, with as much detail as possible, the question(s) and 

res onse s in section 36. 

26 If it was in response to an unsolicited question, did the speaker state that N/A 

the information was not part of the approved indication for the product and 

provide the medical liaison officer contact information? 

27 If lt was in response to an unsolicited question, did the speaker q,~~Yl 

respond to the question by providing the medical liaison officer contact 

information and return to the resentation? 

28 Describe any anecdotal information on the product that was shared W'i:th 

attendees, and how the speaker made it clear that these were his/her 

personal opinion or professional judgment, and did not represent lNSYS 

Thera eutics' osition. ifoff-label 

29 Describe any anecdotal information added by ttle,,Sates representative. 

Note: This excludes formulary and/or patient ai.si!liant ~rogram questions 

30 Describe an lavish or deluxe features at the venue 

31 Was the program free from entertainment or recreation activities? 

32 Was the program free from gifts? If no, describe in detail the gifts that were 

distributed 

33 

34 

35 

36a Ffll out a row below for each question asked by the attendees that did 

m>t an,,,.ar consistent wfth the aooroved oroduct indications. 

N/A .· < 

'',, '•' 

37a Based on the monitor's experience, describe areas where the~ 

repres!mtatiYe exhibited behavlor(s) that repr..Sent leading practices 

(e.g., Particu/arly engaging prfJgram, sales representative that 

seamlessfv intearates cfJmollilnce Into their stvle etc.I? 

Rep is relatively new and was well presented -"flQ'.Specrnc compliance 

intearation was noted 

38 Other Comments and Observations (e.g. duration of the program was 

not sufficient rofJ much extra information added ro the tille slide t 

Poor choice of venue, relatively hard to hear the presentation - much have 

this tvoe of oroaram in a nrivate room 

The event was originally scheduled at 7:00 PM but did not commence until 

7·35 PM due to a late arrival bv a HCP 

Page 26 of 41 

Confidential 

N/A 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

The second HCP that arrived late got a brief summary of the product and the deck was 

not shared as it should have been as the speaker was rushing to make a flight home and 

eat 

The table was in the middle of a crowded and loud restaurant where patrons were within 

armslenoth of the sneaker and audible nresentation 

See attendee box above 

Access to system is not given to the monitors 

Remarks 

Did very well controlling the conversation 

N/A 

N/A 

N/A 

N/A 

Verify with INSYS 

Speaker Response (document exactly how the question was handled by the 

soeaker1 

N/A 

Based on the monitor's experience, describe areas where the ~exhibited 

behav1or(s) that represent leading practices (e.g., particularly engaging speaker, 

SMSker that seamlessly integrates compliance into tfleir style, etc.)? 

The speaker was able to accurately present the data that was on each slide, and did an 

excellent iob to articulate it in a loud venue 

Confidential 

INS4289795 

I NSYS _HSGAC _ 00007798 
Checklist 

Progr~m Logistics 

Program Contacts (lNSYS Sales Representative, Additional 1NSYS 

Attendees, ClS Monitor, INSYS Monitor) 

Program Location (venue name, street address, city, state) 

ProQram Type (In-Office, Venue-based, Marketing, Virtual, etc,) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

How long was the presentation (in minutes)? 

How long was the Q&A (in minutes)? 

Enter the total dollar amount from the duplicate receipt, obtained from the 

venue or food delivery company (excludinq AV, room rental, parkino) 

General Program Information 

Was PowerPoint presentation used the same as the approved slides noted 

1 durina oroduct trainina? 

If handouts were disseminated to the audience, were all the materials 

INSYS approved? Collect materials and note the lNSYS document 10 #in 

2 the Remarks section 

Was the presentation/exchange of information knowledge at a minimum 30 

3 minutes for in-office proqrams and 45 minutes for vendor proQrams? 

Category 1 • Feedback to Speaker/Safes Representative (if appropriate) 

Describe the transition between the disease state and product sections of 

the resentation. 

All safety information was presented during the program (e.g., discussed at 

some point during presentation and/or attendees had enough time to read 

the safety slides)? lf safety information was not presented in its entirety do 

not rovide feedback and describe in cate or 4 

lf paper slides were used for the presentation, were they collected at the 

conclusion of the ro ram? 

Cate o 2 - Feedback to s ea/rer/Safes Re resentative if ro riate 

If handouts were disseminated to the audience, were they distributed after 

completion of the disease awareness portion of the speaker program 

ex lain how the handouts were disseminated ? 

Did the speaker (or sales rep if speaker is introduced) disclose that the 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Yation remains Category 2. If 

sign age/other materials or program setting indicates I NSYS Therapeutics 

sponsorship, note the obse1Yation and provide feedback as Category 1 that 

this should be done orall 

Yes/No 

Yes 

Yes 

No 

' ,,, 

Yes 

N/A 

Yes/No 

N/A 

No 

Was there at least one attendee from an institution or office other than the Yes 

Was a sales representative present during the entire presentation? (Note: Yes 

this is not a requirement, however, it is good to note if the representative 

11 did not sta for the duration of the ro ram 

12a No 

12b No 

If two sales representatives were present atthe program, did the total No 

13 RSVPs or attendees exceed 12 HCPs? 

If two sales representatives were present atthe program, did the second No 

14 re resentative leave before the be innin of the resentation? 

If two sales representatives were present at the program, and the second 

representative did not leave before the beginning of the presentation, was 

15 there rior a roval? 

Page 27 of 41 

Confidential 

Yes 

INSYS Speaker Program Compliance Monitoring Report 

C1S Monitor: Adam Toronto 

INSYS Sales Representative· Fernando Serrano 

lNSYS District Manager: Jonathon Roper 

other: Dr. Fanto, (2 HCPs), Rachel Ortense, 

Capitol Grill - Midtown Manhattan 

Venue-based 

Friday, December 13;,,J1Q13 - 8:1 D PM 

SUBSYS® 

Advancements in the Treatment of Breakthrouqh Pain in Cancer Patients (BTCP) 

Dr. Steve Fanto, MD 

27 minutes 

N/A; 

No specific Q&A but questions were asked durinq the presentation. 

Paid by INSYS Corporate 

Remarks 

,'', 

EX.ample v• .... '" [" INSYS spray was hartdecfout and used by one of the attendees 

I : 

,,,', 

', 

'',,,, 

Remarks 

The speaker did a very thorough Job at transition from section to section Disease state 

to actual reduct, use, and titration was well aefmed. 

Paper slides were not used for the presentation. Only the approved deck electronically 

on an !Pad provided by the rep. 

Remarks 

No handouts were disseminated after the disease state portion 

2 re s/ 1 District Mana er 

Accordin to the re there were onl two 

Second sales representative present is new and was shadowing for educational purposes 

Confidential 

INS4289796 

I NSYS _HSGAC _ 00007799 
Category 3 - Feedback to Speaker/Sales Representative (If appropriate) Yes/No 

If an offsite program, were all participants who received a meal also present Yes 

16 for the entire infonnation presentation? 

Was the event held in a private room away from the general public? No 

17 

Did the sales representative require the attendees to sign into an Yes 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s), Yes 

speaker(s), INSYS employees), Note: Some offices may refuse to allow 

their employees to sign in, and in those cases the representative has to 

19 note the refusal to sign.pees it match the number observed? 

List the number of attendees entered into the speaker program system N/A 

(including the monitor(s), speaker(s), INSYS employees), Does it match 

20 the number on the sign-in sheet(s)? 

Category 4 • No feedback to the, Sa/es Representathtes/Speakers by Monitor Yes/No 

Was a slide deck presented at the program? Yes 

21 

22 Did the speaker use only approved 1NSYS Therapeutics slides, which Yes 

included the 1NSYS references/watermark? If no, comment in the Remarks 

section regarding specific slides added by the speaker. * 

23 Was at least some of the mandatory safety information presented during Yes 

tl1e presentation and/or did the attendees t1ad ample time to read tl1e 

safety slides? Note: Incomplete coverage of the mandatory safety slides is 

considered category one. lfsafety slides were not skipped in their entirety, 

describe in cate or 1. * 

24 Did the speaker limit the discussion to product or disease state information 

that is consistent with the a roved reduct indication? 

Yes 

25 lfno, was the information given in response to an attendee's unsolicited N/A 

question? Document, with as much detail as possible, the question(s) and 

response(s) in section 36. * 

26 If it was in response to an unsolicited question, did the speaker state that N/A 

the information was not part of the approved indication for the 

provide the medical liaison officer contact information? 

27 If it was in response to an unsolicited question, did the speaker only 

respond to the question by providing the medical liaison officer contacif 

information and return to the presentation? * 

28 Describe any anecdotal information on the product that was shared with 

attendees, and how the speaker made it clear that these were his/her 

personal o_pirnon ~r profes.sional judgment, ~d di~ !'\O\ represent lNSYS 

Therapeutics' position.* (if off-label) ,,~:,, ,, , . ; 

29 Describe, any anecdotal information actcfecl l:lylhe, ales rep1'1'sentative: 

Note: This excludes formulary andf<?f p;att~rit assistant progra~ guestions 

30 Describe any lavish or deluxe features at the venue, 

31 Was the program free from entertainment or recreation activities? 

other product$',.* ' ' 

34 Did the meal provided stay with the limit of the INSYS Therapeutics 

Compliance Policies ($125/attendee 

excluding AV, room rental, and parking?* 

35 Enter the sp l:<15!!'r~ tionorarium 

Page 28 of 41 

Confidential 

N/A 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

The table was in a comer of a restaurant where there was some privacy but still within 2-3 

arms lengths of other patrons in the restaurant 

See attendee box above 

Access to system is not given to the monitors 

NOTE: questions with a *require notification to ABC Pharma 96 hours after the 

program has occurred 

Did very well controlling the conversation 

N/A 

N/A 

N/A 

Moderately loud restaurant 

N/A 

Verify with INSYS 

N/A 

Confidential 

INS4289797 

INSYS_HSGAC_00007800 
36a Fill out a row below for each question asked by the attendees that did 

not anrv:oar consistent with the aaoroved oroduct lndications. 

Attendee stated that the majority of his patients were pain patients and not 

post chemo/cancer patients etc Then stated that the product could easily 

be used for BACK PAIN in the middle of the night with more ease than 

takinn a nill form nain killer. 

37a Based on the monitor's experience) describe areas where the §.il.fJ:§. 

a:nresentative exhibited, behavlor(s} that represent leading practices 

(e.g., partlcu/arly engaging program, sales representative that 

seamlesslv intearates comnliance into theirstvle~ etc.J? 

NIA 

38 Other Comments and Observations(e.g. duration of the program was 

not sufficient too much extra in'farmatfon added ta the title slide) 

Verify whether or not HCP (female) is actually a physician. 

The event was originally scheduled at6:30 PM but did not commence until 

8:10 PM due to a late arrival by a HCP 

Page 29 of 41 

Confidential 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Speaker Response (document exactly how the question was handled by the 

saeakerJ 

The speaker did state upon hearing that that SUBSYS needed to be used only for 

breakthrough cancer pain in adults and was not medically indicated for back pain 

Based on the monitor's exper;ence, describe areas where the~exhlbited 

behavior(s) that represent leading practices (e.g., particularly engaging speaker, 

speaker that seamlessly Integrates compliance into their style, etc.)? 

Speaker dealt with an HCP that was very interruptive and not really paying attention. The 

second HCP paid no attention whatsoever and the monitor questioned whether or not she 

was an actual practicing HCP of a friend/some other association of the HCP and along for 

the meal. (T~ b:,ve~fi~d)h The speaker was able to c?nnect o.n specific levels and_ keep 

the conversatio('FgD'ifi!l:with respect to safety, product information such as lypophyl!c and 

reaction tim~~--t~at ~monstrated pr?duct knowledge and engagement brining the 

conversation back, to a SU BSYS ooint when it had veered off 

•. ·. 

:. 

Confidential 

INS4289798 

INSYS_HSGAC_00007801 
Program Logistic$ 

Program Contacts (INSYS Sales Representative, Additional INSYS 

Attendees, ClS Monitor, INSYS Moni1or) 

Program Location (venue name, street address, city, state) 

Program Type (In-Office, Venue-based, Marketing, Virtual, etc.) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

How long was the presentation (in minutes)? 

How long was the Q&A (in minutes)? 

Enter the total dollar amount from the duplicate receipt, obtained from the 

venue or food delivery company (excluding AV, room rental, parking) 

General Program Information 

Was PowerPoint presentation used the same as the approved slides noted 

1 during product training? 

If handouts were disseminated to the audience, were all the materials 

INSYS approved? Collect materials and note the lNSYS document 10 #in 

2 the Remarks section 

Was the presentation/exchange of information knowledge at a minimum 30 

3 minutes for in-office oroarams and 45 minutes for vendor oroorams? 

·· .. 

category 1 - Feedbai:k to Speaker/Safes Representative (ff appropriate) 

Describe the transition between the disease state and product sections of 

the resentation 

All safety information was presented during the program (e_g_, discussed at 

some point during presentation and/or attendees had enough time to read 

the safety slides)? If safety information was not presented in its entirety do 

not provide feedback and describe in category 4 

lf paper slides were used for the presentation, were they collected at the 

conclusion of the ro ram? 

Cate o 2 - Feedback to s eaker!Sa/e$ Re re:;entative if ro riate 

Yes!No 

Yes 

N/A 

Yes 

Yes 

Yes 

Yes/No If handouts were disseminated to the audience, were they distributed after N/A 

10d 

10e 

completion of the disease awareness portion of the speaker program 

ex lain how the handouts were disseminated ? 

Did the speaker (or sales rep if speaker is introduced) disclose that the 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Vation remains Category 2_ If 

signage/other materials or program setting indicates INSYS Therapeutics 

sponsorship, note the obse1Vation and provide feedback as Category 1 that 

this should be done orall 

No 

Was there at least one attendee from an institution or office other than the No 

s eaker's? 

Was a sales representative present during the entire presentation? (Note: Yes 

this is not a requirement, however, it is good to note if the representative 

11 did not sta for the duration of the ro ram 

If two sales representatives were present atthe program, did the total No 

13 RSVPs or attendees exceed 12 HCPs? 

If two sales representatives were present atthe program, did the second No 

14 re resentative leave before the be innin of the resentation? 

If two sales representatives were present at the program, and the second No 

representative did not leave before the beginning of the presentation, was 

15 there rlor a roval? 

Page 30 of 41 

Confidential 

INSYS Speaker Program Compliance Monitoring Report 

C1S Monitor: Erin Jen 

lNSYS Sales Representative· Andrew McNaughton 

lNSYS District Manager: Tiffany Cromartie 

2301 Camino Ramon 

#140 

San Ramon, CA 

In-Office 

Wednesday, December 18, 2013 -12:59 PM 

SUBSYS® 

Advancements in the Treatment of Breakthrough Pain in Cancer Patients (BTCP) 

Dr. Ravi Panjabi, MD 

26 minutes 

5 minutes 

·. i 

Remarks 

I .. 

Remarks 

The speaker did a very thorough JOb at transition from section to section Disease state 

to actual reduct, use, and titration was well aeflned. 

Remark$ 

Speaker did mention that he was being sponsored by SUBSYS. and all the slides were 

from the SUBSYS slide deck. However, there was no mention of INSYS 

Confidential 

INS4289799 

INSYS_HSGAC_00007802 
Category 3 - Feedback to Speaker/Sales Representative (if appropriate) Yes/No 

If an offsite program, were all participants who received a meal also present N/A 

for the entire information presentation? 

16 

17 Was the event held in a private room away from the general public? Yes 

Did the sales representative require the attendees to sign into an Yes 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s), N/A 

speaker(s), INSYS employees), Note: Some offices may refuse to allow 

their employees to sign in, and in those cases the representative has to 

19 note the refusal to sign.pees it match the number observed? 

List the number of attendees entered into the speaker program system N/A 

(including the monitor(s), speaker(s), INSYS employees), Does it match 

20 the number on the sign-in sheet(s)? 

Category 4 • No feedback to the, Sa/es Representatives/Speakers by Monitor Yes/No 

Was a slide deck presented at the program? Yes 

21 

22 Did the speaker use only approved lNSYS Therapeutics slides, which Yes 

included the 1NSYS references/watermark? If no, comment in the Remarks 

section regarding specific slides added by the speaker. * 

23 Was at least some of the mandatory safety information presented during Yes 

tl1e presentation and/or did the attendees t1ave ample time to read the 

safety slides? Note: Incomplete coverage of the mandatory safety slides is 

considered category one. 1fsafety slides were not skipped in their entirety, 

describe in cate or 1. * 

24 Did the speaker limit the discussion to product or disease state information Yes 

that is consistent with the a roved reduct indication? 

25 lfno, was the information given in response to an attendee's unsolicited N/A 

question? Document, with as much detail as possible, the question(s) and 

response(s) in section 36. * 

26 If it was in response to an unsolicited question, did the speaker state ~hat N/A 

the information was not part of the approved indication for the prod~ '2nd 

rovide the medical liaison officer contact information? ,,,, 1 

27 If it was in response to an unsolicited question, did the speaker onlY] 

respond to the question by providing the medical liaison officer cont8tt 

information and return to the presentation? * 

28 Describe any anecdotal information on the product that was shared with 

attendees, and how the speaker made it clear that these were his/her 

personal opinion or professional judgment, an:d dfd not r~present 1NSYS 

Therapeutics' position,• (if off-label) 

29 Describe. any anecdotal informatiori at;lde~ by the .sales repr'e~~tative .. 

Note: This excludes formulary and/orpafie11t,ass1stant prograf'll(lU,estions 

30 Describe any lavish or deluxe features at the venue. 

31 Was the program free from entertainment or recreation activities? 

32 Was the program free from gifts? lf no, describe in detail the gifts that were 

distributed. * 

33 Describe a!"J<':dfrect tomparisons th~! were '!lade between,,~e'p!oduct and 

other prodliil: s): * : 34 Did the meal provided stay with the limit of the INSYS Therapeutics 

Compliance Policies ($125/attendee 

excluding AV, room rental, and parking?* 

35 Enter the speakeis J10110ra,rium. 

36a Fill out, a row below tor each question asked by the attendees that diq 

not an,,,.ar consistent with the aooroved oroduct indications. 

N/A : 

r 

I 

37a Based on the monitor's expe.rfence, descfibe areas where ,the~ 

representative exhibited behavior(s) that represent leading practices 

(e.g,, particularly engaging program, sales representative that 

seamtesslv intearates como/iance into their stvle, etcJ? 

N/A 

38 Other Comments and Observations (eg, duratton of t/ie program was 

not sUfficient, too much extra information adcfed to the tftle slide) 

N/A 

Page 31of41 

Confidential 

N/A 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

Not an off-site program - However, two office staff members came in and left during the 

presentation. Two other office staff members were in the office and may have eaten the 

food after the presentation HCP was present for entire information presentation 

Office break room 

N/A. C1S monitor did not collect sign in sheet at the end of presentation. Monitor was 

asked to sign in, and witnessed the HCP and speaker sign in as well 

Access to system is not given to the monitors. 

NOTE: questions with a *require noiifica:fion to INSYS 96 hours after the program 

has occurred 

Via lpad 

No off-label discussions. Speaker gave anecdotal information regarding dosages and ho 

his patients were much more comfortable and less irritated at doses under 600mg. He 

stressed slide 20 that most patients receive over 600mg doses, but did state start at 

1 OOmg. Speaker mentioned that he has his patients bring the used products back in 

their next appointment to ensure none are in the wrong person's hands 

Tiffany gave advice regarding ordering units vs. doses 

N/A. Did not have access to receipt. Meal was limited to pizza and salad from zpizza. 

Speaker Response (document exactly how the question was handled by the 

soeakerJ 

N/A 

Based on the {110n~or's experience, describe areas where the speaker exhibited 

behavlor(s) that represent leading practices {e.g., particularly engaging speaker, 

speaker ,that seamlessly integrates compliance into their style, etc.)? 

N/A 

Confidential 

INS4289800 

INSYS_HSGAC_00007803 
Speaker Program 8 Checklist 

Program Logistics 

Program Contacts (lNSYS Sales Representative, Additional lNSYS 

Attendees, CIS Reviewer, INSYS Monitor) 

Program Location (venue name, street address, city, state) 

Program Type (Jn-Office, Venue-based, Marketing, Virtual, etc.) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

How long was the presentation (in minutes)? 

How long was the Q&A (in minutes)? 

Enter the total dollar amount from the duplicate receipt, obtained from the 

venue or food delivery company (excluding AV, room rental, parking) 

General Program Information 

Was PowerPoint presentation used the same as the approved slides noted 

1 during product training? 

If handouts were disseminated to the audience, were all the materials 

INSYS approved? Collect materials and note the INSYS document 10 #in 

2 the Remarks section 

Was the presentation/exchange of information knowledge at a minimum 30 

3 minutes for in-office programs and 45 minutes for vendor programs? 

Category 1 - Feedback to Speaker/Safes Representative (if appropriate) 

Describe the transition between the disease state and product sections of 

the presentation 

All safety information was presented during the program (e.g., discussed at 

some point during presentation and/or attendees had enough time to read 

the safety slides)? 1f safety information was not presented in its entirety do 

not rovide feedback and describe in cate or 4 

Yes!No 

Yes 

N/A 

No 

Yes 

lf paper slides were used for the presentation, were they collected at the Yes 

conclusion of the program? 

Category 2 - Feedback to Speaker/Sales Representative (if appropriate) 

If handouts were disseminated to the audience, were they distributed after 

completion of the disease awareness portion of the speaker program 

(explain how the handouts were disseminated)? 

Did the speaker (or sales rep if speaker is introduced) disclose that the 

program was sponsored by INSYS? 

Note: lfno verbal disclaimer was made that INSYS Therapeutics is 

sponsoring the program, the obse1Vation remains Category 2. If 

signage/other materials or program setting indicates INSYS Therapeutics 

sponsorship, note the obse1Vation and provide feedback as Category 1 that 

this should be done orally 

Yes/No 

No 

Yes 

Was there at least one attendee from an institution or office other than the Yes 

speaker's? 

10a How many HCP attendees were atthe event? 

10b How many speaker(s) were at the event? 

1 Oc How many sales representatives were at the event? 

1 Od How many monitors were at the event? 

1 Oe Total number of people at the event and took part in the meal 

Was a sales representative present during the entire presentation? (Note: 

this 1s not a requirement, however, it 1s good to note if the representative 

11 did not stay for the duration of the program) 

12a No more than two representatives were present at the program? 

12b Were there at least 3 RSVPs pnor to proceeding with the program? 

If two sales representatives were present at the program, did the total 

13 RSVPs or attendees exceed 12 HCPs? 

Yes 

Yes 

Yes 

N/A 

If two sales representatives were present atthe program, did the second N/A 

14 representative leave before the beginning of the presentation? 

If two sales representatives were present at the program, and the second N/A 

representative did not leave before the beginning of the presentation, was 

15 there prior approval? 

Page 32 of 41 

Confidential 

INSYS Speaker Program Compliance Monitoring Report 

ClS: Eugene Shvartsman 

lNSYS Sales Representative: Sonia Palermo 

Prime Bistro 

305 Central Avenue 

Lawrence, NY 11559 

Venue-based 

Thursday, December 19, 2013 -8:41 PM 

SUBSYS® 

Advancements in the Treatment of Breakthrough Pain in Cancer Patients (BTCP) 

Dr Phillip Fyman, MD 

27 minutes 

5 minutes 

$500,00 l 

-. ~ti "' -

Remarks 

<·I '',,, 

The presentation was presented via laptop 

Remarks 

The speaker provided a brief ove1View of the history of fentanyl, then provided SUBSYS 

specific information 

Remarks 

Copies of the presentation were disseminated at the beginning of the presentation. None 

of the attendees kept the handouts therefore, they were collected back by the sales 

representative 

5 (The fifth person, who is not included in 1 Oa-d was the speaker's office manager and 

wife) 

Confidential 

INS4289801 

INSYS_HSGAC_00007804 
Category 3 - Feedback to Speaker/Sa/es Representative (ff appropriate) Yes/No 

If an offsite program, were all participants who received a meal also present Yes 

16 for the entire information presentation? 

Was the event held in a private room away from the general public? No 

17 

Did the sales representative require the attendees to sign into an Yes 

18 attendance list? 

List the number of attendees on the sign-in sheet(s) (including monitor(s), No 

speaker(s), INSYS employees), Note: Some offices may refuse to allow 

their employees to sign in, and in those cases the representative has to 

note the refusal to sign.pees it match the number observed? 

19 

List the number of attendees entered into the speaker program system N/A 

(including the monitor(s), speaker(s), INSYS employees), Does it match 

20 the number on the sign-in sheet(s)? 

Category 4 - No feedback to the Sales Representat/ves/Spe;;l<ers l>Y Monitor Yes/No 

Was a slide deck presented at the program? Yes 

21 

22 Did the speaker use only approved lNSYS Therapeutics slides, which Yes 

included the lNSYS references/watermark? If no, comment in the Remarks 

section re ardin s ecific slides added b the s eaker. * 

23 Was at least some of the mandatory safety information presented during Yes 

the presentation and/or did the attendees had ample time to read the 

24 

25 

26 

27 

28 

29 

30 

safety slides? Note: Incomplete coverage of the mandatory safety slides is 

considered category one lfsafety slides were not skipped in their entirety, 

describe in cate or 1. * 

Did the speaker limit the discussion to product or disease state information 

that is consistent with the a roved reduct indication? 

If no, was the information given in response to an attendee's unsolicited 

question? Document, with as much detail as possible, the question(s) and 

response(s) in section 36. * 

If it was in response to an unsolicited question, did the speaker state :that 

the information was not part of the approved indication for the product ~Ff 

rovide the medical liaison officer contact information? 

If it was in response to an unsolicited question, did the speaker only 

respond to the question by providing the medicaJ Jiaissu1 officer contact 

information and return to the presentation?~ 

Describe an,y,anecdotal info,rmati,on• on~, R~?~uct, thatWa,,s,,···S~,a,r,ed with attendees, and how the speaker made it clear that these wete1h1s/her 

personal opin:on or professional JUcig!llent, and did not repres4nt INSYS 

Therapeutics' position,• (If off-label) 

Describe. any anecdotal information adde~-O¥:!f:e.sales represen~!ve.­

~ote: This excludes formulary and/or patient as?t.tant progr~/!!.~€;:.~~ns. 

Describe any lavish or deluxe features at the venue 

31 Was the ro ram free from entertainment or recreation activities? 

32 Was the program free from gifts? lf no, describe in detail the gifts that were 

distributed. " 

33 Describe anydrect comparisons that were madE} between the:prQduct and 

other produ'C s 

35 

36a Fill out a row below for each question asl<ed by the attendees that did 

not an,,,,ar consistent with the aooroved oroduct indications. 

NIA ,' I 

,,,, '~, 

: 

37a Based on the mom"tor's experience, describe areas Where the uJ.u.. nmresentative exhibited behavior(s) that repre{ient /ead1i1g practices 

(e,g,, particularly engaging program, sales representative that 

seamlessfv intearates comoliance into their stvle etcJ? 

NIA 

38 Other Comments and Observations (e,g, duration of the program was 

not sufficient too much extra information added to the title slide) 

Subsequent to the presentation, the speaker noted that INSYS was doing 

well within the stock market 

The event was originally scheduled at 7:30 PM but did not commence until 

8:41 PM due to a late arrival by a HCP 

Page 33 of 41 

Confidential 

Yes 

N/A 

N/A 

N/A 

36b 

37b 

INSYS Speaker Program Compliance Monitoring Report 

Remarks 

The meeting took place at a table located in the front of restaurant The table was in a 

non-private setting, in a high traffic area and the surrounding noise level was high 

1 Speaker 

1 Speaker's Office Manager, who was also his wife 

1 HCP 

1 Monitor (CIS) 

1 Sales Representative 

Access to system is not given to the monitors. 

NOTE: questions with a *require notification to ABC Pharma 96 hours after the 

program has occurred 

None 

None 

None 

As noted in the slides, the speaker compared SUBSYS and ACTIQ, CIS noted that no 

other products were not mentioned during the presentation 

speaker R<!$ponse {document exactly how the question was handled by the 

soeakerl 

NIA 

Based on tile monitor's experience, describe areas where the~exhibited 

behavior(s) that represent leading practices (e.g,, particularly engaging speaker, 

speaker that seamlessly integrates compliance into their style, etc.)? 

N/A 

Confidential 

INS4289802 

INSYS_HSGAC_00007805 
INSYS Speaker Program Compliance Monitoring Report 

Appendix J: Documentation Eight (8) Cancelled Programs which included 

Cancelled Program 1 

Page 34 of 41 

Confidential 

Travel 

Confidential 

INS4289803 

INSYS_HSGAC_00007806 
Cancelled Program 2 

Page 35 of 41 

Confidential 

INSYS Speaker Program Compliance Monitoring Report 

Confidential 

INS4289804 

INSYS_HSGAC_00007807 
Cancelled Program 3 

Page 36 of 41 

Confidential 

INSYS Speaker Program Compliance Monitoring Report 

Confidential 

INS4289805 

INSYS_HSGAC_00007808 
Cancelled Program 4 

Page 37 of 41 

Confidential 

INSYS Speaker Program Compliance Monitoring Report 

Confidential 

INS4289806 

INSYS_HSGAC_00007809 
Cancelled Program 5 

Page 38 of 41 

Confidential 

INSYS Speaker Program Compliance Monitoring Report 

Confidential 

INS4289807 

INSYS_HSGAC_00007810 
Cancelled Program 6 

Program Logistics: 

CIS Reviewers 

Program Location (venue name, street 

address, city, state) 

Program Type (In-Office, Venue-based, 

Marketing, Virtual, etc.) 

Program Date & Start Time 

Brand 

Presentation Title 

Speaker(s) 

Sale Representative 

INSYS Speaker Program Compliance Monitoring Report 

Adam Toronto 

Stephen Pyles 

1807 Ross Avenue 

Dallas TX 75201 

Vendor 

12/09/2013 7:00pm 

SUBSVS® 

Advancements in the Treatment of 

Breakthrough Pain in Cancer Patients (BTCP) 

Dr. Christopher INce 

Lance Clark -,---,~~,..,..,,,,----~::-;:--.,,.,,---,:-----,-c""7--,--!-.,,..,-....,-...,...,-...,.....,...,.,..,....._,.,,,,,,....,..,..-_,,..-.,-.,...,._.....,..,...,,..,,,,..,.....-..,,,..,,....,-.,...,....,..,,..,...~..,,...,,....,.....,,...i 

On the evening of December 9 , 2013 the monitor arrived to the location at 6:45pm and when he asked 

where the program would be taking place or if the INSYS representative had arrived, the staff informed the 

monitor that the representative had called two (2) hours previous to cancel the program without reason. The 

monitor called the INSYS home office contact Desiree Hollandsworth to enquire as to why the program was 

cancelled. Due to a weekend of poor weather and ice storms, the HCP opted to not attend the program and 

the INSYS representative did not cancel and notify the proper channels in a timely manner. This resulted in 

subsequent upfront travel fees, billable time, food, and lodging to be covered with no service provided. 

Page 39 of 41 

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Confidential 

INS4289808 

INSYS_HSGAC_00007811 
INSYS Speaker Program Compliance Monitoring Report 

Cancelled Program 7 

Program Logistics: 

CIS Reviewers Adam Toronto 

Program Location (venue name, street Arthur's Steakhouse 

address, city, state) 27 Rah lings Ave 

Little Rock AR 72223 

Program Type (In-Office, Venue-based, Vendor 

Marketing, Virtual, etc.) 

Program Date & Start Time 11/05/2013 6:30pm 

Brand SUBSVS® 

Presentation Title Advancements in the Treatment of 

Breakthrough Pain in Cancer Patients (BTCP) 

Speaker(s) Dr. Ahmoud 

Sale Representative Casey Hannock 

·- h "' .... .. \ ·. .. c • .. .• •• .\ ... ' ( .. \.• .<. \ '\ ... ~ ·.· .... ·· .. ? . \\ !<\,, .> ·. • ..?:: ... ' .• ; .•. '. :<<\\~2;;; <·· ~.>·:< 

On November 5'", 2013 the monitor arrived at the location at 6:15pm and was directed to a private room that 

was very well set up. It was private, had a projector, and upon arrival SUBSYS example placebos were placed 

on the tables as well as SUBSYS documentation. Both the rep and the speaker were punctual and at 7pm the 

rep assured the monitor that there were at least 3 RSVP's out of the 8 that were confirmed the peceding 

night via INSYS scheduling systems. The monitor, speaker, and rep sat for another hour with no HCPs present. 

The speaker and rep ate full meals and the monitor opted out. The meeting was called as no HCPs arrived 

despite communicated constant and real time updates that they were in route. 

Page 40 of 41 

Confidential 

Confidential 

INS4289809 

INSYS_HSGAC_00007812 
INSYS Speaker Program Compliance Monitoring Report 

Cancelled Program 8 

Program Logistics: 

CIS Reviewers Ryan Stewart 

Program Location (venue name, street Yolo 

address, city, state) 5841 Transit Road 

East Amherst, NY 14051 

Program Type (In-Office, Venue-based, Vendor 

Marketing, Virtual, etc.) 

Program Date & Start Time 11/11/2013 6:30pm 

Brand SUBSYS® 

Presentation Title Advancements in the Treatment of 

Breakthrough Pain in Cancer Patients (BTCP) 

Speaker(s) Dr. Romanth Waghmarae 

Sale Representative Michael Volansky 

,.,,;;:;..../;&: - rn >'.\ Z•+: :' • \ Y•• • J' ! ·• .•... ,\ \ •• •: :':;.:·. '. • • •: ···•··. . : j;, .· .. v . ;,CZ. . \:: \.: ; ,, \;~; c • • ·.··•·• '.", >.\ }: \ !'.•j;;;; 

CIS Reviewer; Ryan Stewart, arrived at Yolo located at 5841 Transit Road, East Amherst NY at 6:15 pm on 

Monday, November 11th, 2013. Per Michael Volansky, he called to confirm with the attendees the day ofthe 

program and they cancelled. Michael Volansky and Dr. Waghmarae, the speaker, still attended dinner at 

YOLO. 

.'. . 

Page 41of41 

Confidential 

Confidential 

INS4289810 

INSYS_HSGAC_00007813