More Than a Game of Keep Away - Pharmaceutical Executive

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More Than a Game of Keep Away
The PDRP takes effect in July. The AMA explains how individual doctors can keep their prescribing habits safe from reps, and how pharma can keep using the anonymous data—if the industry polices itself.


Pharmaceutical Executive


Although the guidelines attempted to prevent misuses of data and to preserve the inherent value of the information to other healthcare constituents, they did not entirely succeed. Some sales representatives did misuse data and, as a result of this behavior, physician complaints and negative sentiments intensified.

In 2004, several national and state medical societies, led by the American College of Physicians, formally requested the AMA to prohibit the release or sale of physician prescribing information. In order to gauge the severity of the issue and attempt to develop a solution, the AMA polled hundreds of America's physicians to determine their attitudes on the subject. The AMA Board of Trustees considered the findings of the survey and the floor discussions in the AMA's House of Delegates, and listened to representatives of the healthcare industry, as well as HIOs. Ultimately, the board recommended that a program be created to:

  • Provide physicians listed in the AMA Masterfile with an "opt-out" mechanism to prevent details of their prescribing practices from being shared with pharmaceutical sales representatives and other "restricted employees"
  • Explain to physicians how they can report inappropriate behavior on the part of pharmaceutical employees
  • Work with HIOs to help physicians understand how information about their prescribing is used, and to create reports for physicians from the data to enhance their clinical practices.

This opt-out mechanism has grown into the PDRP. In addition to providing physicians with a choice about having their prescribing data released to reps, the AMA is in the process of refining and strengthening its best-practice guidelines. The revised guidelines further clarify appropriate uses of prescribing data and set forth certain expectations for representatives' behavior. The thinking is that by providing physicians with real options and by cutting down on the number and frequency of data abuses that physicians encounter, fewer physicians will want to enroll in the restriction program. Stricter enforcement of the guidelines, coupled with active self-monitoring on the part of pharmaceutical companies, can only help the situation.

Making the Case to Physicians

How many physicians choose to participate in the program remains to be seen. To make sure that physicians have all the facts before they decide whether to enroll, the AMA will be communicating with all of its members and affiliates beginning this month. In these communiqués, the AMA will explain what options are open to physicians, and emphasize the important role that prescribing information has in the healthcare market.

Although the industry has not actively promoted the usefulness of compiling and releasing prescribing data, physicians and the public have a vested interest in doing so because the data can:

Reduce healthcare costs Opponents of prescribing data have argued, erroneously, that using prescribing data to support pharmaceutical sales and marketing somehow burdens the healthcare system with additional cost. The facts suggest just the opposite. Prescribing data allow pharmaceutical promotion to be relevant and specific, making the whole process more cost-effective (and sparing physicians from being bombarded with extraneous promotional materials and sales calls).

Support appropriate levels of drug sampling If companies could not tell which physicians most needed samples, they would likely distribute them evenly, with the result that some physicians would have too many, and others too few. Again, this would add costs to the system and fail to support patients' needs.

Help prioritize the release of public safety news alerts Based on physician prescribing details, companies can identify which physicians need to be contacted first in the event of a newly identified side effect or a product recall.

Give physicians a unique view of their own practice HIOs are piloting information products to physicians (as recommended in the 2004 AMA board report) that can reveal important facts about a physician's own practice: the degree to which patients comply and persist with treatment, patients' use of generics, and how the physician's prescribing practices compare with those of his or her peers. The data can also be used to provide valuable information for pay-for-performance systems that drive improved clinical practices.

The initial program of this type is currently being piloted in California. Commenting on this initiative, Jack Lewin, MD, CEO of the sponsoring California Medical Association said, "We are optimistic that this program can put doctors on a more level informational playing field, grant them better insight into their own practices and those of peers, and ultimately lead to better patient care through better use of information."


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