Marketing of Enbrel investigated

TRENTON, N.J. – First one former sales representative, then another from drug maker Amgen Inc. claimed they were fired or forced out for refusing to go along with unethical, even illegal practices to boost sales of the pricey drug Enbrel among psoriasis patients.

Now two federal agencies and four state attorneys general are investigating the practices of the company, according to the sales reps’ New Jersey lawyer.

Amgen’s sales force was pushed to encourage dermatologists to switch psoriasis patients from other treatments to Enbrel, even if they had common medical conditions Enbrel could have worsened, said ex-saleswoman Elena Ferrante of Montvale, N.J., who said she was fired in August 2005 after eight years of “outstanding” performance reviews.

Ferrante said doctors were paid to host outreach programs where they would laud Enbrel to psoriasis patients – even those with just a mild form of the disfiguring skin condition. Use of Enbrel, a blockbuster genetically engineered drug that patients inject once or twice a week, is not approved for people with mild psoriasis, who normally get inexpensive topical creams or generic pills.

Amgen, of Thousand Oaks, Calif., denies any wrongdoing.

Enbrel can cost more than $30,000 a year. It’s only approved for patients with moderate to severe psoriasis and can have severe side effects, even fatal infections. The drug also is used for rheumatoid arthritis and rarer autoimmune disorders.

Enbrel was first approved as a psoriasis treatment in April 2004. That opened a huge new market, as about 7 million Americans have some degree of psoriasis, Ferrante said.

That’s when Amgen started pushing very aggressive, unethical marketing strategies for Enbrel, said Ferrante and another former Amgen rep, Marc Engelman of Laguna Niguel, Calif. He said he resigned last year after getting his first negative performance review because, like Ferrante, he would not use such tactics.

In interviews, both said they had been pushed – but refused – to have doctors let them examine patient medical files for psoriasis patients who might be switched to Enbrel, a clear violation of patient privacy laws. The reps said they were urged, with other salespeople, to write patients under doctors’ letterhead inviting them to Enbrel sales pitches disguised as informational seminars, and to seek approval from insurers for coverage.