It shouldn’t be surprising that pharmaceutical companies work with physicians in developing new medicines and educating health care professionals about their use. In fact, more than 500 full-time Lilly employees are physicians.
Yet, looming over the working relationships between manufacturers and outside physicians is a suspicion that companies are just paying doctors to prescribe their products.
At the end of September, the Centers for Medicare and Medicaid Services (CMS) launched the new Open Payments website – as required by “Sunshine Act” provisions of the health care reform law – disclosing financial relationships between pharmaceutical and medical device companies and physicians and teaching hospitals.
Our industry supported the Sunshine Act. Well before its passage, companies like Lilly worked to improve transparency – beyond what we were required to do at the time – with our own online databases of payments to physicians and with industry codes of conduct guiding ethical relationships.
We’ve worked to provide to CMS accurate data and meaningful context about the collaborations between physicians and manufacturers. We believe this kind of transparency can help alleviate public concerns about these necessary and appropriate relationships.
The key to meaningful information is to put payments in context. Without such context, headline numbers don’t mean much – and indeed may be misleading.
A striking example: Jonathan Rockoff of the Wall Street Journal highlighted one doctor for which the CMS website listed $7.4 million in payments from a medical device maker. But, as Rockoff reported, it turns out that the “eye-popping” sum actually represented royalties on 25 patents associated with a minimally invasive shoulder surgery the physician invented and spent 25 years developing.
The big picture: The figures reported on the CMS website – $3.5 billion in financial relationships – amount to less than 1 percent of U.S. sales of pharmaceuticals and medical devices in 2013.
There are very good reasons for companies like ours to contract with physicians. That’s why we’ve welcomed transparency and are working on this issue not only in the U.S. but around the world.
Based on data from the companies that have maintained databases prior to the Open Payments website, about two-thirds of physician financial relationships are related to clinical research – massive studies conducted by independent researchers testing potential new medicines in hundreds or thousands of patients. Clinical trials are required in order for new medicines to be approved.
But what about advising and speaking fees? Are they legitimate? The simple fact is that companies like Lilly really do need physicians’ expertise as we develop promising molecules. In fact, our industry has been criticized in the past for not listening to physicians and patients to make sure that new therapies actually address unmet needs. The advising fees we pay physicians are investments in better medicines.
Likewise, a medicine can’t be effective if it doesn’t reach the people who can benefit from it. We depend on physicians to help educate colleagues about new treatment options. According to the PhRMA Code on Interactions with Healthcare Professionals, speakers must clearly identify the company on whose behalf they are presenting. And, of course, speakers must also adhere to the very strict regulations that govern our communications about our medicines.
Travel and meals are a normal part of doing business in any field, but such reimbursements to physicians are a particular source of suspicion.
In my view, there are two keys to maintaining public trust: First, strict internal policies on qualified expenses are needed to ensure that paying for a trip or a meal is not a veiled attempt to “buy the business.” Second, a full accounting of payments will allow the public to judge for itself.
Here’s the most important context for evaluating this data: Physicians across this country prescribe medicines that they believe will best meet their patients’ needs. Their medical judgment can’t be bought.
This simple fact was recently borne out by some research with a surprising result.
A United Healthcare study of cancer care payment models compared a large national database of payments to doctors in a typical fee-for-service model – with reimbursement based in part on the number of cancer medicines prescribed – with five volunteer groups of doctors that were reimbursed for an episode of care based on quality measures. It turns out the doctors reimbursed for quality actually prescribed more chemotherapy than those who had a financial incentive to do so. And, what’s more, while chemotherapy costs rose in the episode-of-care model, overall costs declined 34 percent – without a reduction in quality of care.
Transparency alone won’t restore trust in our industry. In fact, it’s likely to raise more questions in the short term. It’s important that we continue to work with CMS to help it provide data disclosures that are meaningful and easy to understand. And we must continue to address skepticism by maintaining the highest ethical standards in our relationships with physicians.
We believe that effective and appropriate relationships with physicians and medical institutions are essential aspects of our efforts to improve individual patient outcomes, to help guide development of new medicines that address patient needs, to inform health care professionals and patients about various diseases and treatment options, and to educate patients about how to use our medicines.
I believe that’s the context for understanding the Open Payments database, and it’s why we welcome this new level of transparency.
