Healthy Skepticism Library item: 19747
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: Journal Article
APhA on 'bounties' to pharmacists
Scrip 1994 Oct 28; (1970):17
Full text:
Patients who receive prescriptions through programmes which pay pharmacists for getting patients switched from one brand-name product to another should be given information about the payments, according to draft ethical guidelines issued by the American Pharmaceutical Association (APhA).
The APhA drafted the guidelines to help pharmacists decide whether to participate in some of the newer “incentive” programmes, such as those intended to increase compliance or encourage product switches, sponsored by manufacturers or third-party administrators (eg pharmacy benefit management companies). As pharmacists wrestle with the ethics of the situation, some argue that such reimbursement amounts to bribery, noting that there is a fine line between reimbursement for counselling and being a paid rep for a company. Others counter that being paid is merely the pharmacist’s due as the drug therapy expert.
The association said the draft guidelines are “especially timely” in light of a recent fraud alert released by the DHHS’ Office of the Inspector General (OIG), which notified pharmacists that some prescription drug marketing practices potentially violate the Medicare and Medicaid anti-kickback statute (Scrip No 1953, p 18). The association is circulating the guidelines to members for comment, and plans to have the document reviewed by state pharmacy associations, manufacturers, several state attorneys general, the OIG, and the FDA.
“Disclosure of all material facts about a programme (including the existence of and amount of the remuneration received by the pharmacist from the programme sponsor) must be made to patients so that they can make fully informed decisions about whether or not they wish to participate in the sponsored programme”, the guidelines state. Disclosure must either be directly to patients or through pharmacists and/or prescribers, and sponsored programmes must document that the patient has 1) received all material facts about the programme, and 2) given his or her consent to participate in the programme.
The guidelines would allow participation is sponsored programmes as long as patients or their health plans received therapeutic and/or economic benefits. The draft states: “The wellbeing of the patient is the paramount consideration in the design, development, and implementation of all these programmes, regardless of the sponsor.” Programmes that are therapeautically or economically neutral to the patient, but result in economic savings to the provider or health plan, are also acceptable.
…fair remuneration
The APhA has said on several occasions that it supports compensation for pharmacists’ services, particularly “cognitive services” (ie when a pharmacist counsels patients to check the suitability of the medication to general wellbeing, etc). The guidelines state that reimbursement to pharmacists has historically been tied to the cost of the medication, rather than the value of services provided to patients. “APhA supports seperate payment systems that distinguish between compensation for the provision of pharmaceutical care and other cognitive services, and reimbursement for product distribution,” the draft notes.
Some community pharmacists have argued that drug-switch programmes are at least an attempt to compenstate pharmacists for providing extra services which might improve the quality of care. These same pharmacists also question why they have been singled out by attorneys general and the Inspector General – particularly when similar drug-switch programmes are being used in hospital and health maintenance organisation formularies, and by mail-order companies and pharmacy benefit management units.
…patient privacy
The guidelines also address the issue of patient privacy. “Preventing disclosure of patient-specific information to non-healthcare providers without explicit patient approval is paramount,” the guidelines maintain. Patient specific information – such as name of the patient, the amount of the prescription dispensed, the diagnosis or medical condition of the patient, the name of the prescriber – may be revealed by pharmacists only with the consent of the patient.
…state actions
Over the past year, companies have been critised for offering payments (so-called “bounties”) to pharmacists in return for patient counselling involving suggestions that patients switch their medicines. The legality of Miles’ programme for its Adalat CC and Upjohn’s for Glynase PresTab were eventually challenged by state authorities, which brought civil charges. The companies, without admitting any wrongdoing, stopped the efforts and settled the charages for $605,000 and $672,000 respectively. There were concerns that the programmes may have violated state consumer protection laws because the payments to pharmacist were not disclosed to doctors and patients, the states said (Scrip Nos 1947, p 15 & 1913, p 15).
In a recent letter to the state board of pharmacy, Minnesota attorney general Hubert Humphrey said that the trust in pharmacies “as sources of independent, neutral, professional health services…must not be subverted through hidden payments to [them] from drug manufacturers for promoting or favouring the manufacturer’s products.”
