In July, the Pharmaceutical Researchers and Manufacturers of America (PhRMA) released its revised "Code on Interactions with Healthcare Professionals," which addresses the scope of permissible pharmaceutical company interactions with and marketing to healthcare professionals.

In 2002, PhRMA published its original, voluntary code of ethics that established standards of conduct for pharmaceutical companies dealing with healthcare professionals. The theory behind the Code is clear: The risk is that providing certain benefits to healthcare professionals may cause them to prescribe a drug or product based on receiving these benefits rather than using independent clinical judgment.

The new Code, effective January 1, 2009, will replace PhRMA's 2002 Code and further restrict the types of permissible interactions between pharma reps and healthcare professionals. The revised Code includes additional processes by which pharmaceutical companies electing to comply may be publicly recognized by PhRMA. Companies that publicly announce their commitment to abide by the provisions of the Code will be recognized on PhRMA's Web site upon the completion of an annual certification signed by the company's CEO and chief compliance officer. Moreover, the revised Code encourages companies to seek independent verification of their compliance with the PhRMA Code by having an external source verify, at least once every three years, that the company has adopted and implemented policies and procedures to foster compliance.

What's Changing?

Non-Educational Items In contrast to the 2002 Code, the revised Code prohibits a pharmaceutical company from providing healthcare professionals with any items that do not advance disease or treatment education. Even practice-related items of minimal value, such as pens, notepads, mugs, hats, t-shirts, mouse pads, and similar items with a product or company logo, are prohibited. Likewise, pharmaceutical companies should refrain from sending boxes of cookies, candy, and gift baskets to physicians' offices. (Pharmaceutical companies may still provide items designed primarily for education, such as anatomical models.) This new prohibition represents a major departure from PhRMA's previous position with respect to practice-related items.

Informational Presentations and Meals Pharmaceutical companies are now precluded from providing restaurant meals to healthcare professionals. Occasional meals may still be offered, but only if both they are both attending a bona fide informational presentation during the working day, and such presentation takes place at either a physician's office or hospital. Sending lunch to a physician's office is, in general, no longer permissible.

Entertainment and Recreation The revised Code strengthens PhRMA's prohibition on providing entertainment and recreation items to healthcare professionals, such as tickets to theater and sporting events, treating physicians to golf, and providing free sports equipment (such as golf clubs, golf balls, or general sports memorabilia) and leisure trips (i.e., vacations, boating, fishing/hunting trips, or any other travel-related excursion). These items should not be offered to any healthcare professional who is not a salaried employee of the pharmaceutical company, regardless of: the item's value, whether the healthcare professional is engaged as a speaker or consultant, or whether the benefit is secondary to an educational purpose.

Retention as Consultants The importance of pharmaceutical companies entering into consulting arrangements with healthcare professionals is still recognized. However, decisions regarding the retention of healthcare professionals as consultants should be based on defined, objective criteria such as medical expertise, reputation, and experience. Compensation should be for legitimate services (i.e., not a reward for prescribing or recommending a particular product), and should be reasonable and fair market value in all respects. In order to document and verify that the compensation paid to consultants is fair market value for bona fide speaking and consulting services, pharmaceutical companies should carefully monitor the tasks that the consultant performs, the approximate amount of time spent on such tasks, and the compensation paid to the consultant. One further caveat: The 2009 Code imposes additional requirements on arrangements with healthcare professionals who participate in committees that develop formularies or clinical practice guidelines. Before a pharmaceutical company engages such a professional as a speaker or consultant, the professional must disclose his/her prospective relationship with the pharmaceutical company to the committee in which he/she participates. This disclosure requirement should be ongoing, and extend for a period of two years after the termination of the professional's arrangement with the pharmaceutical company.

CME Grants Further guidance is provided regarding the circumstances under which a pharmaceutical company may provide certain support for CME, such as: Decisions regarding CME program grants should be separated from (and not influenced by) sales and marketing departments; objective criteria should be established for CME grant decisions; the independent judgment of the CME provider should be respected, and applicable accreditation standards should be followed; and no advice or guidance should be provided to the CME provider regarding the content or faculty of a particular program, even if such advice is solicited.