states (including Illinois); others states have stricter requirements, such as requiring that a letter
refer to a specific individual patient and do not allow "blanket" PALs. Bristol Myers helped
Omnicare solicit PAL letters illegally.
Bristol Myers took the following actions in furtherance of its conspiracy with
Omnicare to illegally switch patients on ACE inhibitors to Monopril:
Making false statements to Omnicare front line pharmacy personnel as to the reason for
Bristol Myers made false
representations Omnicare staff,
to Omnicare pharmacy through "kickoff" and
designed to maximize the wholesale switching, and through making for technical consultations. These false representations included:
That the switch to Monopril was financially advantageous to private insurers, when this was almost never the case.
the government and
That Monopril was clinically the most appropriate ACE inhibitor, when
frequently this, too, was not the case.
Making false statements to physicians as to the reasons for the switching. Bristol Myers made its marketing perSOll.11CI available at Omnicare-serviced nursing homes to work with Omnicare consultant pharmacists to convince physicians to sign PALs authorizing wholesale switches.
Failing to disclose kickbacks and other financial interests to physicians in helping Omnicare solicit PALs. Bristol Myers did not disclose to physicians that it was providing kickbacks to Omnicare for switching certain types of medications to "preferred" medications.
Requiring Omnicare to develop computerized electronic capability to accurately track levels ofparticipation in the illegal PAL solicitation program by site and by prescribing clinician.
Rewarding Omnicare for the proportion of patients switched to Monopril via illegal switching payments based in part on the success of the switching scheme.
Working in close coordination with Bristol Myers' marketing staff, Omnicare's
consultant pharmacists became a front line army pressuring physicians into signing PALs. Each
PAL allowed Omnicare to switch all ACE inhibitor prescriptions to Monopril from other
manufacturers' drugs within the same therapeutic class. Omnicare's actions in furtherance of the