"Prescriber Education Service" - Ensure Safety and Accuracy in Prescribing Decisions: Key Facts, Polling, Best Practices

Policy Overview: Establish a Prescriber Education Program, or “academic detailing” initiative, for the dissemination of scientific and clinical data about the effectiveness and costs of pharmaceuticals and medical devices. Such a program can reduce state health care costs and improve medical quality. States have several options for funding education programs outside of the general fund, including a fee on manufacturers and federal grants.

Link: Model Legislation for an Act to Ensure Safety and Accuracy in the Prescribing of Prescription Drugs and Medical Devices

Key Facts on Prescriber Education Programs: Prescriber Education Programs aim to provide better information to medical providers and consumers about which drugs are the most effective and have the least adverse effects, as well as the costs of those drugs. Unlike drug company salespeople (aka “detailers”), who focus on a particular drug sold be the salesperson’s company, Prescriber Ed. Programs provide objective, clinical information on a range of treatments including non-pharmaceutical options.

• Prescriber Ed. Programs save money by supporting chronic disease management and reducing purchases of unnecessary or more costly pharmaceuticals that have the same — or lesser — degree of efficacy, or medicinal value.
• A formal cost-benefit analysis of a 4-state Medicaid study involving 435 doctors showing savings of $2 for every $1 the program cost, based on just Medicaid paid claims data.

Key Facts on Marketing: In its marketing, the drug industry gets the greatest bang for its buck by providing physicians with biased information on a drug’s efficacy and through gifts to physicians. The industry habitually markets the most expensive drugs over less expensive, yet equally or more effective medications, like generics.

• The drug industry spends $30 billion marketing its product each year, of which $6.7 billion is spent on direct-to-physician marketing.
• On average, $8,800 in marketing is spent on each physician in the US. The industry sends 90,000 sales reps to pitch the newest “celebrity” drugs in doctor’s offices and hospitals, armed with an expensive meal, office supplies with the company logo, and drug samples.
• 94% of doctors have received industry incentives and studies show that even small gifts create an unconscious "demand for reciprocity."
• "Doctors who have close relationships with drug makers tend to prescribe more, newer and pricier drugs" regardless of a drug’s value compared to less expensive medications, as the New York Times reported in 2007.
• Drug manufacturers spend more money marketing drugs than developing new ones.

Key Facts on Drug Prices: The pharmaceutical industry is raising its prices at the fastest rate since 1992. Critics identify this as an attempt to wedge in higher prices before Congress passes health reform that may clamp down on exorbitant drug prices and begins expanding coverage to millions of Americans. Leading up to the creation of the Medicare Part D drug benefit, which notably lacked authority for Medicare to flex taxpayers’ purchasing power to negotiate lower prices, drug manufacturers raised their prices at the widest margin in 6 years. The industry has so far protected its profits by spending more than almost all other lobbies in Washington, DC.

• In 2007, the U.S. spent $287 billion on pharmaceutical drugs, representing 14% of all health care expenditures and a significant driver of health care costs.
• 1 in 7 Americans reportedly went without prescribed drugs in 2007, up from 1 in 10 in 2003.

Polling Data:

• According to a 2008 survey from the Pew Prescription Project:
  • 71% of Americans support “provider education programs” that provide unbiased clinical non-commercial information about drugs to physicians.
  • 68% support requirements on the drug industry to disclose gifts to physicians;
  • 86% would ban free dinners;
  • 80% support a ban on speaking fees;
• 70% of Americans say the industry puts profits before people, according to a 2005 Kaiser Family Foundation poll.
• 74% of Americans believe the drug industry makes too much profit, according to a November 2009 Associated Press poll.
• 9 in 10 Americans support the government using its buying power to negotiate lower prices from drug companies, which many states are already doing, according to a recent Kaiser Family Foundation/Harvard poll.

For more, see Pew and Community Catalyst's public opinion survey on American's concerns about drug industry gifts and other ties to physicians and a recent Kaiser Family Foundation/Harvard/NPR survey on the public's opinion of the role of health care interest groups in health reform.

Best Practices and Funding: A state's surest way to finance a prescriber education program is to assess a fee on manufacturers who participate in Medicaid and other programs. Other sources of revenue include Medicaid match and federal grants. For a limited time, ARRA funds are available as part of the stimulus' promotion of comparative effectiveness research initiatives. The Agency on Health Research and Quality (AHRQ) is accepting applications until December 16, 2009, for funding of up to $1.5 million per project. Annual costs for these programs range from $1 million in Pennsylvania to $50,000 in Vermont.

In addition to our model legislation, several states have enacted prescriber education programs, including the following: Pennsylvania’s model program, called Independent Drug Information Services, is a partnership between the state and Harvard Medical School. Vermont’s program is run by the University of Vermont Medical School and Maine’s program is a collaboration between the Maine Medical Association and the State. Massachusetts (HB 4900), New Hampshire (HB 1513), and New York are also implementing systems.