Drugmakers & PBMs Square Off Over E-Prescribing
10 CommentsBy Ed Silverman // February 14th, 2011 // 11:36 am
A behind-the-scenes battle is brewing in nearly a dozen states where legislation has been introduced to more closely regulate e-prescribing. And a trade group for pharmacy benefit managers claims that brand-name drugmakers are trying to use the proposals to restrict access to lower-cost generics.
The bills would, essentially, prohibit docs from seeing messages from third-party information providers as they write an e-prescription. In doing so, info about other prescribing options, including drug interactions, would not be displayed on screens. “By removing the third party message, the legislation doesn’t allow the technology to get to the doctor,” a spokesman for the Pharmaceutical Care Management Association tells us.
Legislation is pending in 11 states, including Indiana, Kansas, Mississippi, Missouri, Nebraska, New Mexico, New Jersey, North Dakota, Oklahoma, Pennsylvania and South Dakota, according to PCMA.
In testimony last month before Nebraska’s House Human Services Committee, Pfizer lobbyist Paul Ploftchan said that one key issue to consider is the possible disruption between the physician-patient relationship. “The greatest threat is that third parties may use e-prescribing to infiltrate and inappropriately influence the clinical decision making process at the critical point of care,” he testified. “These intrusions, driven by financial interests, represent inappropriate influence and rarely have the patient’s best interest at heart” (read his statement here).
A PhRMA spokesman sent us this statement: “PhRMA is currently reviewing e-prescribing legislation introduced in a number of states. We believe e-prescribing legislation should be designed to promote effective communication between physicians and patients in order to determine the best treatment options available for individuals. In addition, we support an e-prescribing system that provides physicians with patient information at the point of care and allows for timely approval of prescribed treatments. E-prescribing holds the potential to vastly improve the quality of care provided by our health care system. It can also help control costs. “
RPJ
Pfizer lobbyist Paul Ploftchan … “The greatest threat is that third parties may use e-prescribing to infiltrate and inappropriately influence the clinical decision making process at the critical point of care,” he testified. “These intrusions, driven by financial interests, represent inappropriate influence and rarely have the patient’s best interest at heart”
Remind me, what is that old saying about the kettle and the pot? ….
Logic worthy of Tea Party endorsement.
John Klatt
I’m a drug rep for pharma, and I find this to be the most hypocritical thing I have ever seen. It’s ok to send in armies of reps to influence a doctor, but not ok for the people paying for the drugs to do the same thing. Come on. Like pharma doesn’t have financial motives, but the patients best interest at heart. Give me a break. If the docs are smart enough to make informed decisions after I talk with them, then I trust they will do the same when they e-prescribe.
Insider
Dear John, YOur right. Pfizer does not put out very good information for physicians to use anyway and it is 100% financially motivated. But you have a lot of guts to put your comments out there. It is a rough world these days for reps.
doc
“The greatest threat is that third parties may use e-prescribing to infiltrate and inappropriately influence the clinical decision making process at the critical point of care,” he testified. “These intrusions, driven by financial interests, represent inappropriate influence and rarely have the patient’s best interest at heart”
Silly me, and I thought the Pfizer lobbyist was speaking about pharma company reps when he said this!
If this display of hypocrisy doesn’t show the true colors of big pharma, I don’t know what does. And they wonder why the public views them at the same trust level as used car salesmen?
WiscoRPh
In this case the Pfizer guy is dead on. The more insidious financial incentive is the PBMs using e-prescribing to drive physician decisions while having no idea of the patient’s condition or profile. PBM’s are motivated ONLY by drug component costs, not the patients well-being. E-prescribing only gives PBMs formularies more power and shifts the risk to the patients and their doctors. While generics are a great way to save money, they only do so when that medicine is the most appropriate for that patient. If not, the costs of a medical re-do far outweigh the drug cost savings, not to mention the patient suffers with delayed appropriate treatment.
Its easy to blame the manufacturer here, but that’s a red herring for the PBMs to hide behind. Agreed that e-prescribing makes it much easier to communicate, make records available for better treatment decisions, reduce costs, reduce errors, etc. but it is imperative that the systems be built without the ability for nefarious interests to exploit.
lee333
John K and WiscoRph are exactly right.
The only intent of PBM formularies is $$$$$$$$:
“preferred brands”, “select generics” with back-door rebates to rationalize the list and the order of presentation on e-prescribing systems.
Prescribers should take great insult that their training and knowledge is impuned so.
As an RPH, we see daily the manipulations driven by buck$$$$ only.
The additional costs added to the system by PBM “savings mechanisms”:PRIOR AUTHS AND STEP THERAPIES is the fourth most frequent lie…propriety prevents my listing of the three originals…
George Rontiris
I spoke with a physician today, who told me that when he is about to send an E=Script to a patient’s selected pharmacy, he is now getting messages suggesting other pharmacies, such as Medco Mail order. This too will be an issue.
Insider
Very good information, much more complicated then we coudl imagine. Nice job with the insight from the pharmacists. Looks like the Pfizer guy was actually doing the right thing for a change.
doc
I disagree with those extolling the virtues of Pfizer’s lobbyist. Sure PBMs want more money, but no more than pharma companies.
Generic substitution saves billions of dollars. If we have an issue with generic quality, then the FDA is the issue.
What pharma doesn’t want even more then generic substitution is therapeutic substitution, but too bad - it’s coming faster than ever.
The doctor has the ability to say no, I want an ARB, because they already failed an ACEI.
The rebates that PBMs demand are only a way for them to get some reduction in pricing of branded pharma products. This enhances their bottom line, at the expense of the pharma’s bottom line, who then passes the cost on to patients and taxpayers.
Looking for a white knight in the situation will prove fruitless, but putting a lobbyist for Pfizer in that role is ridiculous.
patty west
Has anyone considered the millions of dollars poored into electronic medical records and the incentives the goverment is giving to doctors to pay for their cost, without the e prescribing those doctors CAN’T QUALIFY for those incentives.