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
- 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
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."