New Pharma Code: No Pens, But Lunch Is Free
48 CommentsBy Ed Silverman // July 10th, 2008 // 7:03 am
All those cheap pens and mugs, along with other gifts, given to doctors will no longer be allowed under new voluntary guidelines being issued by PhRMA, the US trade group. But there are no limits on speaking and consulting fees for docs, and routine free meals in physician offices - plus dinner invites to educational events - will still be permitted.
Drugmakers are supposed to certify in writing that “they have policies and procedures in place to foster compliance with the code,” which will go into effect in January. The code, by the way, doesn’t cover biotechs or device makers, which have their own trade groups, but these haven’t taken such steps.
The code requires annual limits on amounts to be paid docs to deliver educational talks, although limits aren’t specified, which could make it easier to comply with a national registry. Token consulting or advisory arrangements should not be used to justify compensating consultants for their time or their travel, lodging, and other out-of-pocket expenses. Here is the PhRMA press release and here is the code.
PhRMA last updated its marketing code in 2002, when it banned “dine and dash” events in which drugmakers provided free take-out dinners, Christmas trees and gas to docs who agreed to listen to brief sales pitches, The New York Times reminds us. The earlier code also banned golf outings and free tickets to sporting events, which remains in effect.
“It strikes me as an attempt to persuade people against doing anything that’s serious,” Sharon Treat, who heads the National Legislative Association on Prescription Drug Prices, tells the paper. But Herb Kohl, a Wisconsin Senator, who co-sponsored the Physician Payments Sunshine Act, which would require drug and device makers to disclose payments of more than $500 to docs, tells the Times: “We’ve been pushing to see reforms like this for some time now. Consumers will undoubtedly be the beneficiaries of these industry changes.”
What do you think?
Should free lunches be banned?
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- Yes (38%, 97 Votes)
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Doc
It’s a start. One of our Presidents at a recent meeting told us that “there was a significant announcement coming from Pharma soon to improve the industry image”. Guess this is it, pretty underwhelming.
harpy
Devicemakers aren’t out of the woods on this one - California, and more recently Nevada, require adherence to the PhRMA Code to do business in their states, and they include devices in their statues (CA 1765 and NV AB 128). Unfortunately, devicemakers get lumped in with pharma quite often, even though it ought to be considered a different industry. The relationship with doctors is completely different.
Dan
No office supplies anymore is minor in comparison of the most concerning issue- and that is where pharma’s money goes when doctors accept this money for doing little if any work for the pharma company. Such attempts and reform within pharma are to keep the possibility of regulators discovering and confirming what big pharma does in particular, which is bribe and reward doctors, depending on the circumstances.
Justice in MI
My understanding is that PhRMA is now supporting the proposal to have disclosure on moolah to docs (for whatever reason) over $500. Clearly, that’s were the action is; not pens.
SP
Is this a joke? No pens or mugs, but no statement about the millions dumped into the pockets of Key Opinion Leaders! This is like spittin’ in the ocean. The real problem is the pocket lining action. When are the Big Pharma and medical Device companies going to open up those books? The buying of business has been rampant over the past 10 years. It’s just hidden and covered up.
Ed Silverman
Hi Justice,
Yes, pharma now supports the Physician Sunshine Payments Act, although drugmakers only started to do so after the bill was watered down. The revised bill calls for drugmakers to publicly report gifts over $500; originally, that was $25. And fines were reduced to between $1,000 and $50,000 for each violation. The earlier proposal set fine at $10,000 to $100,000 per violation.
The support occurred back in May…
http://www.pharmalot.com/2008/05/drugmakers-back-watered-down-disclosure-bill/
Cheers
ed
Dave
Maybe this is a good thing. I mean who needs a pen with the price of gas these days. Perhaps it would pay for sales reps to return to the old days of talking with docs while they fill their tanks at a local service station.
Pump #1 for oncology
Pump #2 for diabetes
Pump #3 for cardiology
Justice in MI
Thanks, Ed. Thought I remembered that. I recall a post in which I said Lisa could only give me a gift of $499 so it didn’t have to be reported….!
Do you know (sorry to be lazy) when this goes into effect (has it?) and where the “registry” will be? How accessed?
atlex
JiM,
This goes into effect on 1/1/09.
Atlex
Paul G
I think it is a good move.
Once again, all of those who are critics for life will never be satisfied. They call and call for these changes and, when they come, they say “not enough, we want more”.
I still believe that when compared to politicians at all levels, all these perks are tiny in comparison. No, that doesn’t make it right, but look who’s calling the kettle black.
Let’s applaud a move in the right direction.
Chris
To clarify, under the Physician Sunshine Act, most if not all payments to physicians above a certain amount (not only gifts) appear to require disclosure. (Also, PhRMA support was also linked to a desire for preemption of state-specific disclosure laws.)
Also interesting is that the House version of this bill appears to preclude tax-deduction of marketing and advertising expenses for a company assessed a penalty for noncompliance:
`(a) In General- No deduction shall be allowed under this chapter for any taxable year for any expenditure relating to the advertising, promoting, or marketing (in any medium) of any covered drug, device, or medical supply manufactured by the taxpayer if, during the taxable year, a penalty is imposed on the taxpayer under section 1128G(d) of the Social Security Act (relating to quarterly transparency reports from manufacturers of covered drugs, devices, or medical supplies under Medicare, Medicaid, or SCHIP).
Pharma Whore
No promotional items, no reps allowed. What else do they want to take away, people are getting killed by this industry left and right, without taking any pharmaceuticals.
Hang in there all of you displaced promotional vendors. To the rest of you, welcome to Pharma in the new Millenium.
truthman30
Let’s get it straight to the point here..
Pharma has gotten away with breaking its own rules of conduct in regards to ethics, morals and laws for decades now and this has largely gone unnoticed by the general public until the internet age.
It was the advent of the Internet age which blew these widespread practices wide open.
The pharmaceutical industry and those whom work in the industry have no one to blame but themselves for the encouragement and turning of a blind eye to these practices.
No longer can they hide the side effects of defective and dangerous drugs while people are being damaged, no longer can they deny the problems which plague the industry.
Nobody wants to see the end of the industry, most patient and consumer advocates just want to trust in the industry to provide good medicines which work and which benefit humanity. It is in the interest of the whole of society that the ethics of the industry are upheld.
The only shift of paradigm which has happened in this new millennium is the balance of power between the consumers and the industry. the consumer voice has become strong , is being listened to and it is a force of change. This can only be a positive development. In the past, the consumer had no medium of which to voice its concerns. But with the internet and rapid communication this is now possible. It is in everybody’s interest that the balance between any industry and the public is fair, and we are approaching that now. This is a good thing. I can’t see how anyone could argue that the current situation is anything but progress and evolution.
JEAN PUBLIC
I AM NO FAN OF THE DRUG INDUSTRY/MEDICAL INDUSTRY CABAL AGAINST CONSUMERS. IT IS CLEAR THEY WORK TOGETHER FAR TOO MUCH AND THE PATIENT SAFETY AND HEALTH IS OF LITTLE CONSIDERATION. THE DEATHS AND NJURIES REPORTED EVERY DAY AFTER TAKING DRUGS SHOWS THE CARELESSNESS AND INEPTITUDE AND GREED OF THE PEOPLE IN THIS INDUSTRY. THE REVOLVING DOOR BETWEEN THE TWO MEANS YOU PUT IT INTO EFFECT IN GOVT AND THEN LEAVE AND GET A SWISH JOB IN INDUSTRY. THE WHOLE PROCESS STINKS TO HIGH HEAVEN.
Lili
Thank you Jean Public. What you said is true.But our elected and appointed officals support Big Pharma,and are not reporting the side effectts that are causing fatal outcomes. Doctors say patient died from Natural Causes when patient was given unethical medications and care. It is not about gifts, it is about investments and money. New Jersey Patient Safety Act is a farce and so are our Health Care Agencies, they only care aboutthe doctors, healcareindustries and hospitals and not the patients, Governor Corzine is also involved in BigPharma and the restof the corrupt medical rofession.
Atlex
Lilli,
I don’t mean to be flippant, but there are some wonderful treatments for paranoia. Is there some level of corruption? Sure, there always has and always will be. However, the entire healthcare industry, along with government at the state and federal level, do not get together at some secret location to figure out how to screw you.
Atlex
roccaas
Maybe Congress and Presidential candidates should be forced to swallow some of their own medicine. Open the books (really open the books) on how much $$ moves from PAC’s and lobbyists (full tax deduction) to the pockets of politicians.
Maybe if we just take away their pens, pads, and coffee mugs they will go away and sulk for a while and get their hands out of our pockets.
Just think what this will do to the balance of trade with China and India. They make all these chotchkies!
Justice in MI
Truthman writes:
“The only shift of paradigm which has happened in this new millennium is the balance of power between the consumers and the industry. the consumer voice has become strong , is being listened to and it is a force of change.”
I personally wish this were true, but I don’t think it is the pattern in the U.S.. If anything, the trend is in the opposite direction - corporatism has trumped Naderism in most contexts, and has the support of the courts and legislature in more and more states as well as nationally.
This is not a conspiracy theory - it is a swing of the pendulum. I look forward to gravity reasserting itself.
Anonymous
Hey Justice,
Tell me if you will, how many laws I would be breaking if I were to pay docs $ 10.00 for every script they wrote for my product?
Because it happens every day!!!! Some states use this incentive to encourage over the counter medications, as opposed to branded Rx in certain classes of drugs. This is all done in the Medicaid population. Better to have the patient pay out of pocket for an over the counter medication, than to meet their needs by filling a script. (And incidentally, no the over the counter products are not just as effective as branded in all cases, in some instances they request substituted classes of meds for the class originally rxed.)
Effectiveness generally depends on severity of disease, isn’t it the physicians job to make the diagnosis? Or are our medicaid administrators now licensed to practice medicine?
So should I sue the State since I am a representative having to compete with this practice?
And people are all up in arms over trinkets. I personally use them to a minimum. As stated in a previous post. A little something to remind docs that are habituated to their current algorithms that another product exist in a particular category that may be even more beneficial for the patient they are treating, what is the harm? (Clinical experience drives Rx behaviors.)
I hardly think the offense of these trinkets is on the same scale as kickbacks and racketeering.
Justice in MI
Anonymous - I am not a lawyer, so I can’t answer your initial question (maybe facetious).
But I am interested in the practice.
How does it work? Meaning - if a doc tells a pt to go buy OTC Prilosec, how is that documented, who precisely pays the docs, etc.?
Are docs paid for _not_ writing for certain meds? I am trying to figure out how anyone would know.
Former SP
It seems a little strange that Schering-plough hasn’t issued anything about it’s take on the new PhRMA rules. Ditto for Bristol-Myers Squibb. It causes one to wonder why?
harpy
“…how many laws I would be breaking if I were to pay docs $ 10.00 for every script they wrote for my product?”
Well, you’d certainly be breaking the anti-kickback statute, which is really all you need to worry about. Once that line is crossed you’re doomed; anything else is icing. But the state isn’t breaking any laws by paying doctors to prescribe certain medications because they only get an indirect benefit from it. And if you’re selling a script against an OTC - get a new product!
Justice in MI
Harpy - I like your style! Still, I’m curious to learn how states keep track of this one way or other. In the (very) old days, you’d have to send in a “box top.”
Dingle
Justice,
Docs are paid to write Rx meds. Generics are a perfect example. MCO’s are currently paying Docs to write generic scripts for cholesterol meds. It is quite common.
M
I find it interesteing that we continue to move toward trusting our healthcare to the Federal Government and their ethics/morals. Clearly that is a better choice than “Big Pharma”!!??(WT) I’m certain the politicians have our best interest in mind!!! Another question is….. without the ineraction with industry, how many physicians (With all their spare time and money)will continue to seek the cutting edge technologies needed to provide you and me with best chance for a healthy life. Without incentives, “Big Pharma” will not seek to improve medications, and WE will be the benficiaries of that “Shift in paradigm”…..
Anonymous
Justice,
I do not know the specifics for tracking, could be tracking the switches from lets say Nexium to an antacid. I do have established rapport with a # of physicians I call on, and this is a conversation I had about a month ago. He stated that the hospital group administrator that his practice is owned by approached him about utilization rates, specifically related to Medicaid patients. This physician asked if they were asking him to compromise the care of his patients for the benefit of a kickback. As for the “box top” comment Thanks, I enjoyed that immensely at the end of my day! That is a pretty accurate characterization of Pharma at this time. But after the first of the year no more prizes in the cracker jack box.
The PPI market is rather large, the paperwork for prior authorizations can be close to 20 questions. The physician is required to go through this process for each prior auth whenever plan administrators deem appropriate for a class of meds, basically to encourage the path of least resistance.
Regarding my original post, Medicaid does attempt to shift the cost to the individual. From a taxpayer prospective this is a good thing, from the standpoint of free market competition….. Not so good.
Harpy,
I can appreciate your skepticism for competing with OTC products, but if you have any knowledge of classes of meds, I think even you could agree that antacids and PPI’s are not quite in the same category. As far as the State not breaking any laws, or Managed Care kickbacks as noted by Dingle, I don’t know, has that practice been challenged? I imagine Pharma is too concerned for staying out of the spotlight to address the issue.
Peter
Interesting arguments, regarding what are very insignificant changes to present business practice.
The real issue is, in the age of computers and high speed access to information, do we really need a sales rep catering in a $400. lunch. If only to obtain a signature for samples and get a 30 second, “detail”?
Real and inovative change is needed or pretty soon physicians will have a, “do not call”, registry just like we do for telemarketers.
J
Peter -
Don’t think that pharmaceutical companies are not already instituting these practices. One company offers a samples-direct program, on-line “my personal representative”, access to patient education information and to any current and future product information(including published studies) for all healthcare providers. This is an easy solution to customizing the needs of the physician. Yet, this only is a good source if the healthcare provider is self-motivated enough to use it.
Most physicians that I call on feel the overwhelming pressure of Managed Care Organizations influencing their medical practices and prescribing habits more so than any pharmaceutical company. The reimbursement from insurance companies and Medicare/Medicaid has driven them to see more patients which cuts down on the actual counseling time that they have with them. Who wins out in this scenario? Definitely not the patient. And, in the end leaves the physician with little time or energy to use these tools provided by the pharmaceutical companies.
I agree that the pharmaceutical industry as a whole went unchecked for a very long time and a s a representative, the best thing that ever happened to my job were the Pharma Guidelines put through in 2002. My company follows these closely and is probably one of the most conservative in it interpretations. It has actually made my job easier, because I feel that I can actually spend time providing better education and fair balance of my products, without having to wine and dine my physician. The industry has vowed to become “more transparent” and it will take time to see if this actually happens. In the meantime, pens and paper that provide brand recognition are the least of our worries.
Reality
It’s about time! After years of buying business, the Big pharma companies suddenly get a conscience? Not likely. The heat has simply gotten to them and they had to offer up some meaningless concession. My bet is that the thousnads of dollars a day being paid to consultants for very little work will continue virtually unabated.
Observing
Too little too late! I hope that big pharma is not delusional and thinking that all their past sins will be suddenly absolved. Certainly the governement won’t let them off that easy? or will they? In the past 8 years, there hasn’y been much action taking these companies to task for their bad deeds. Are times a changing? Hope so!
harpy
Honestly, Anonymous, I’m becoming less sure of what to think. On the face of it, it certainly seems that a physician receiving cash for writing a prescription a certain way would equal a kickback, but the government makes the rules and enforces them as they so choose. I found the whole Avastin/Lucentis investigation quite shocking as it seemed that Sen. Kohl was berating a company for not selling its product off-label. The example of the past 8 years or so is that the government can break, or rewrite, any law it finds inconvenient. As we all know, “four legs good, two legs better.”
Lisa Van S
Reality,
Wellcome Back,.. I missed you.
Doug B.
Does this mean we have to start dealing with reality again?
Lisa Van S
Doug B., Reality and I have had our differences in the past,.. With that said, I do have to admit,.. the man does have integrity!
Justice in MI
I’m still entirely in the dark about how the point that Anonymous makes works.
I understand about schemes that pay docs for rx’ing generics.
But what system keeps track of _not_ rx’ing a prescription drug at all - say, by suggesting the pt. go buy OTC Prilosec - escapes me.
Move to France
The next time one of you are prescribed a med for your high cholesteral or blood pressure feel free to deny treatment. Obviously the pharma companies are evil and are just out for your money.
There have been problems in the past. Name an industry that has not had problems. Pharmaceuticals is a business not an entitlement to any individual. I trust my physician will make the best decision based on what is wrong not by the pen in his hand. If any of you think a doc is influenced by a pen you have a lot worse problems than that.
Born in the USA
I’m born in the USA and I’m staying here. However, the healthcare system needs some fixing. When it comes to the care of patients, compassion needs to be part of the equation. There are many citizens who are not getting the care they need due to the high cost of services and drugs. These include the elderly, the “working poor”, and the uninsured, The uninsured may have been laid-off, work part-time, are self-employed, or cannot afford it.
Nearly every other developed culture in the world has developed a plan to deal with this. Are they perfect? No. Do they help? Yes. Companies in the healthcare business need to operate with honesty and integrity. Many have lost their way and personal greed rules their actions. These companies need to be part of the solution, whether they like it or not. If they won’t participate voluntarily, then they’ll be forced to do so by the government. I truly hope that they can do it on their own.
Monyonyo
As a pharmaceutical representative I believe that a doctor is more apt to write a particular drug if he is paid to do a presentation on the disease state that includes a set of slides provided by the pharmaceutical company.
This still proves to be pharma’s biggest weapon in gaining revenue. Here’s how it’s done:
The representatives are asked to analyze the physicians in their territory that have the most sales potential. (The drug reps have access to that information which the pharma companies have purchased from drug data sources that are extracted from the retail pharmacy level.) (kudos to Walmart for not selling their data!)
Then they are asked to get those physicians trained “on line” to speak on the disease state and products. The physicians are presented with “honorarium checks” and are happy to be in front of an audience (it’s good for their business too and great supplemental income)
The rep is then asked to leave a voice mail to their manager and report about the speaker. “Did you get a return on your investment, is a manager’s common question. “Did the doctor say good things about our drugs” and “would you recommend him as a KOL (key opinion leader).
KOL’s are considered “superstar speakers” and are often flown around the country to speak at different venues.
Pens and Mugs are nothing compared to Dinner Speaker Programs. Just ask some of the waiters in some of the top steak houses throughout the country.
Seriously, I challenge you to pick one of the most expensive restraunts in your town, drop the name of a couple of different pharma companies and ask how often they conduct business there.
Miles White
As a pharmaceutical representative, I would LOVE to see dinner programs go OUT the window! Only a few of the the lamest physicians attend these events and trying to recruit a live body is merciless! I have to do a few programs a year and it is nearly impossible to determine if anyone will show. Take programs away… Ask any sales rep if they care!
Miles White
PS Peter… No one is forcing your office to participate in lunches! No doubt your morbidly obese office staff felt entitled to order a double lunch including appetizers and desert! Hopefully those gals can still fit into their Nascar scrubs next week! Some offices.. Probably yours.. have the audacity to advertise daily lunch as an added benefit for employment. Save your precious 30 seconds to go beat off fat boy… No one is interested in detailing you.
jane
Miles,
This is not CafePharma. Watch your mouth!
Laurie
Ah, and Miles comes through with the drug rep stereotype! Way to raise the reputation level of your industry.
M
I would echo “Move to France”… If you hate BIG PHARMA sooooo much, just deny your branded pharmaceuticals. That will stick it to them.. Screw those greedy BIG PHARMA people. I must say Reality and Observing have excellent points. I hope you’ll both change your behavior on your next doc appointments and go completely generic for all of your prescriptions… The best way to create change is to stop participating…. By the way, who writes the prescriptions Doctors or BIG PHARMA?
Eggboy
Many of the makers of the pens, mugs, etc. are now going to be forced to close shop or shut down completely. That means people who once had a wage and prescription drug benefits are now going to be without. Don’t forget the truck drivers that have to ship those items or the warehouse with all of it’s workers to store the items.
Thank God our legislators are really looking out for the little guy. These people and these laws are a joke.
Oh, spare me
Ah, It’s good that you’re looking out for Chinese firms and the welfare of their employees.
Optionsmaster
This Phrma guidelines are a BIG joke.
Lets close the real pharma money dumped to the lobbyist groups and “donations” to politicians.
HMO’s already dictate what drugs your doctor can and can not prescibe. All Doctors are degraded to a bunch of brainless monkeys.
What’s the solution? Cap profits on HMO’s and stop “donations” to political groups. Take the “excess” profits and treat the uninsured and pay the healthcare professionals who are actually caring for the ill.
Move to France
The best way to solve this “so called problem” is to get the Gov. involvment out of the Pharma Industry. The only reason the gov has any say is Medicare and Medicaid. Just think how much they will screw it up if Obama, God help us all, is elected.
ConvenientObserver
Notice the wording in the press release…It suggests that give away items will not be allowed by reps during visits to physician offices. However, many of the reps that call on my office have suggested that they will still be able to provide these items at professional meetings and likewise, will also be able to provide restaurant meals to physicians while in attendance at meetings. Have others of you heard similar things from the reps that call on you?