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Omnicare consultant pharmacists to convmce physicians to sIgn PALs authorizing wholesale switches.

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

123.

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

physicians' orders for specific ACE inhibitors to Accupril.

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"

124.

In

much

the

same

way

as

the

wholesale

switching

to

Monopril

was

medically

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

many ways.

125.

First of all, contrary to AMA policies, Pfizer and Omnicare effected switches for

patients who had been stabilized on other ACE inhibitors for years and for patients who had been

switched once before from other ACE inhibitors to Monopril.

126.

Furthermore, Aeeupril was often not the "drug of choice" for a given individual

patient. For stable patients with congestive heart failure with a history of myocardial infarction,

ramipril and trandolapril were indicated as preferable to Accupril. Captopril and trandolapril are

preferentially indicated for stable patients who have had a heart attack and have sustained left

ventricular dysfunction.

34

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