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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 Lipitor via illegal switching payments based in part on the success of the switching scheme.

107.

Pfizer

knew,

intended,

or

reasonably

should

have

known

and

foreseen

that the

Market Share Agreement would induce Omnicare to engage in unauthorized medication

substitution, replacing the independent medical judgment of a patient's physician with that of

Omnicare pharmacists, consulting pharmacists, and other Omnicare employees, by changing

  • o

    That the switch to Lipitor was financially advantageous to the government and private insurers, when this was almost never the case.

    • o

      That Lipitor was clinically the most appropriate statin, when frequently this, too, was not the case.

Making false statements to physicians as to the reasons for the switching. Pfizer made its marketing personnel 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. kickbacks to Omnicare medications.

Pfizer did not disclose to physicians that it for switching certain types of medications

was providing to "preferred"

physicians' orders for specific statins to Lipitor.

108.

In much

the

same

way

as

the

wholesale

switching to

Monopril

was

medically

disadvantageous for many patients, wholesale switching to Lipitor placed patients at risk in many

ways.

109.

First,

contrary

to

AMA

policies,

Pfizer

patients who had been stabilized on other statins for years.

110.

Secondly,

to

responsibly

change

from

and

one

Omnicare

statin

to

effected

switches

for

Pfizer's

Lipitor,

the

prescribing doctor often reqUIres the patient to undergo potentially strenuous fasting

30

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