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Testimony: MA Rx Reform Coalition

RE: S. 2526, An Act to Promote Cost Containment, Transparency and Efficiency in the Delivery of Quality Health Care

• Prescription drugs should be affordable for all patients and payors.
• Pharmaceutical marketing should be focused on getting the right drug to the right person.
• Prescribers and consumers should have access to evidence-based, unbiased information about prescription drugs.
• Decisions of whether to prescribe, what to prescribe and what drugs to cover should be based on timely, unbiased, evidence-based data and should be guided by the best interests of the patient. The process of making those decisions should be transparent.
• Relationships between pharmaceutical companies, prescribers and payors should be transparent and free from conflicts of interest.
• Prescription data should be protected from use in marketing.

also borne by the insured whose insurance premiums and out-of-pocket costs are impacted by high costs. These high costs put consumers at risk for medical debt and bankruptcy. Rising prescription drug costs also threaten the continued success of Massachusetts health reform and the financial stability of the state and employers that provide health care coverage. 

 

Access to needed drugs is also threatened by these high costs. People without any, or adequate, drug coverage are forced to go without needed medications that they cannot afford. More basically, high costs threaten access to insurance plans that include drug coverage. Concerns over the affordability of prescription drug coverage emerged as a critical issue as the Health Connector crafted its Minimum Creditable Coverage standards when employers argued that they cannot afford to offer their employees plans that cover prescription drugs. 

 

S. 2526 seeks to promote prescription drug cost control, thereby ensuring access to prescription drugs, by curbing factors that artificially inflate the price of prescription drugs. The provisions related to prescription drugs in the bill would also improve quality of care by promoting evidence-based medicine.

 

 

Section 7 of S. 2526 seeks to ensure that prescribing decisions are based on unbiased evidence of the effectiveness and safety of a given drug. It directs the Department of Public Health to establish an “academic detailing” program through which medical professionals would provide evidence-based, balanced information about the effectiveness, safety and costs of prescription drugs to physicians and other prescribers in face-to-face visits. Currently, industry salespeople are the primary source of providers’ information about medications. The result is inflated industry influence on prescribing. Academic detailing is similar to pharmaceutical sales visits, except that the academic detailers do not promote a particular product. Academic detailing promotes evidence-based medicine by providing prescribers with unbiased data rather than promotional information.

 

The Massachusetts Prescription Reform Coalition strongly supports a state-sponsored academic detailing program. Academic detailing programs have been repeatedly shown to control costs and increase quality. As a result, an increasing number of states are implementing similar programs. 

 

Academic detailing programs control costs by helping providers identify when less expensive but equally safe and effective drugs are available. As a result, these programs increase prescribing of appropriate lower-cost drugs, such as generics. Savings of $8.3 billion or 11% of total drug expenditures would result if adults appropriately substituted generics for brand names.[ii] It is, therefore, not surprising that research shows that academic detailing programs more than pay for themselves with the amount of money they save the state in health care costs and have the potential to save nearly two dollars for every dollar spent to implement such programs. [iii]  

 

By providing prescribers with unbiased evidence, these programs also assist providers in making safer and more appropriate prescribing decisions. A recent summary of evidence about educational programs aimed at improving patient care concluded that programs that include interactive techniques, like academic detailing, are the most effective means of improving physician practices and patient outcomes.[iv] 

 

 

Section 22 of the bill takes another crucial step toward controlling health care costs by prohibiting pharmaceutical and medical device companies from giving gifts to physicians. 

 

The pharmaceutical industry spends $29 billion annually to market their products, and over
$7 billion annually marketing to physicians alone.[v] A study published in the New England Journal of Medicine found that a staggering 94% of physicians receive meals and other payments from pharmaceutical companies.[vi] 

 

The Massachusetts Prescription Reform Coalition strongly supports a ban on gifts in order to eliminate the inappropriate influence pharmaceutical companies have on prescribing decisions and the resulting cost and quality implications. Excessive pharmaceutical marketing practices contribute directly to rising health care costs. The cost of marketing is passed along in the price of prescription drugs. Marketing also promotes prescribing of more expensive drugs in place of equally safe and effective lower cost drugs, which may be either other brand name drugs or generic drugs. 

 

The provision of pharmaceutical gifts to providers also threatens quality of care. Studies published in the Journal of the American Medical Association show that physician prescribing is highly responsive to marketing.[vii] Gifts and financial incentives from pharmaceutical companies create conflicts of interests that interfere with the ability of health care providers to make prescribing decisions based only on the needs of their patient. 

 

Recognizing the inappropriate influence of pharmaceutical gifts, Minnesota, Vermont, Maine, West Virginia and the District of Columbia have taken legislative action. In Massachusetts, Boston University School of Medicine/Boston Medical Center and UMass Memorial Health Care recently announced new conflict-of-interest policies that ban clinicians from accepting personal gifts and meals from pharmaceutical companies.

 

The Massachusetts Prescription Reform Coalition offers several suggestions to further strengthen the ban and ensure that its intended benefits are realized: 

 

 

 

 

 

 

Thank you for your attention and consideration. The Massachusetts Prescription Reform Coalition seeks to be a resource to you as you consider these provisions. Please do not hesitate to call upon us by contacting Lisa Kaplan Howe at 617-275-2922 or lkaplanhowe@hcfama.org.

 

 

 

 

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