Wall Street Journal Examines Pharmaceutical Contract Provisions
The Wall Street Journal on Friday examined how pharmaceutical companies' contracts with insurers and medical organizations to sell their drugs sometimes restrict "unflattering statements about the costs and risks of drugs when they communicate with health practitioners." For example, Indianapolis-based Eli Lilly offers health facilities a 5% discount for the antidepressant Cymbalta, but the contract states that most of the discount could be revoked if the facility engages in certain actions, including "negative [drug utilization review] correspondence to physicians."
A drug utilization review is a type of analysis of prescription patterns often used by insurers to identify risky or inappropriate practices and to reduce expenses. Pharmaceutical industry officials have said that insurers or other groups could use DURs to encourage doctors to use lower-cost drugs that might not be as effective. The Cymbalta contract also restricts "negative educational counterdetailing," a practice often used by insurers to counterbalance a drug maker's sales pitch to doctors that can focus on recommending generic drugs.
Tarra Ryker, a spokesperson for Lilly, said the Cymbalta contract was not meant to stop communications that are "backed up by clinical data" and "presented in a fair and balanced manner." Ryker said the contract could disallow, for example, a description of side effects without also describing benefits, or it could disallow comparing Cymbalta's cost to a generic drug without also listing the prices of all other antidepressants.
Mohit Ghose, a spokesperson for America's Health Insurance Plans, said, "The signing of contracts does not in any way interfere with the ability of clinicians (at insurance companies) to discuss or disseminate information on the appropriateness, efficacy and safety of any given drug."
However, some insurers are concerned that such contract requirements could "discourag[e] insurers and other groups from disseminating medically relevant information" or "from pursuing DURs altogether," the Journal reports. Dale Kramer, director of pharmacy contracting at Kaiser Permanente, said, "If I signed something like [the Cymbalta contract], I think our clinicians ... would be very upset." He added, "Someone on the business side should not have the authority to make clinical commitments for the company they represent."
Larry Fields, president-elect of the American Academy of Family Physicians, said that although doctors typically pay attention to drug information provided by an insurer or medical facility, they tend to rely more on information provided by physician associations and other sources that "don't have a dog in the fight" (Rubenstein, Wall Street Journal, 8/5).