This Friday at 1:00 pm, WBUR’s show Radio Boston will host Dr. Jerry Avorn and Dr. Leslie Jackowski in a discussion on academic detailing.
Academic detailing is the evidence-based prescription drug outreach and education program that takes information learned through comparative effectiveness research on drugs and translates it into practice for health care practitioners. By using the tactics of pharma marketing, but providing objective information, the program generates better care and cost savings.
According to an economic model developed by Dr. Avorn and Dr. Soumerai at Harvard Medical School and Brigham and Women’s Hospital, every dollar spent on academic detailing returns, at a minimum, two dollars in drug cost savings. Massachusetts began a pilot academic detailing program in 2009, but like so many programs, it has suffered from budget cuts. Despite the limited funding, the program is a success with hundreds of providers getting critical information about Type II Diabetes and Anti-Platelet therapy.
Listen in on Friday (repeated at 3:00 pm on Saturday, or available anytime online after it airs), and then call your state legislator and ask him or her to support funding for academic detailing in the state budget.
-Georgia Maheras
Senators Kohl and Durbin introduced an amendment to the Senate health reform bill that would ban pharmaceutical data mining for marketing. (For a refresher, see this blog explaining data mining)
As reported in the Associated Press, the sponsors of the amendment say that the measure will combat “harassing sales practices” and “restrain undue influence” of pharmaceutical salespersons.
We agree. The Massachusetts Prescription Reform Coalition supports a similar bill in the MA legislature (S. 17/H. 109) that would ban prescription data mining in Massachusetts. The MA law could be implemented much sooner- provided needed cost savings to all MA residents. Massachusetts should again lead the federal government by implementing a ban on data mining. -Georgia Maheras
Budget cuts are eliminating benefits for over 41,300 low income people in Prescription Advantage, which helps seniors and some younger persons with disabilities afford their medications. After a series of budget cuts, starting Januaury 1 the program will only provide a fraction of the assistance it provided just a year ago.
Prescription Advantage will no longer provide premium assistance for Medicare Part D monthly premiums for any Prescription Advantage members. For individuals with less than $16,245 in annual income, Prescription Advantage still provides immediate co-payment assistance (on a sliding scale). For individuals with annual income between $16,245 and $32,490, Prescription Advantage only provides co-payment assistance once a member enters the Medicare Part D Donut Hole ($2,830 in drug costs). For members who have an annual income between $32,491 and $54,150, they must first pay an annual fee of $200 and then Prescription Advantage will provide co-payment assistance once that member has incurred out-of-pocket costs of $3,250.
Because of these significant changes in the program, Medicare members may want to change the Medicare Part D plan in which they are enrolled for a cheaper plan. Part D open enrollment lasts until Dec. 31st. Members can get plan selection advice from their local SHINE office or by calling: 1-800-AGE-INFO.
Community Catalyst, The Massachusetts Health Policy Forum and the Massachusetts Medicaid Policy Institute welcomed Boston’s medical and health policy community on Friday to discuss the MassHealth Prescription Drug Quality and Cost Management program. The forum began with a presentation on the findings of several researchers on implementation of the MassHealth Pharmacy Program . This was followed by a panel discussion of the strategies used to improve drug management and prescriber decision-making. Today’s forum served as an evaluation of MassHealth’s prescription policy changes and helps pave the way for national prescription policy improvements.
Note: this post is from Deborah Banda, State Director, AARP Massachusetts; we join AARP in questioning both the wisdom and the compassion in cutting Prescription Advantage again.
Last Thursday, Governor Patrick closed part of the $600 million mid-year state budget gap by cutting $277 million from state agency budgets. The administration claims that the budget reductions maintain investments in core services. But not all core services were spared.
The Prescription Advantage program, which helps seniors and some younger persons with disabilities afford their medications, will see an additional $5.6 million cut from its $40 million total budget. This continues the unfortunate trend of reducing funding for this core service. The overall program budget has been reduced by a staggering 37% in last three fiscal years, causing 45,000 seniors to lose some of their coverage.
So what does this current round of cuts mean for the low-income enrollees? It means added out-of-pocket costs.
As of January 1, 2010, enrollees will be forced to pay for their entire Medicare Part D premium, as Prescription Advantage eliminates the premium assistance feature of this program. So, for nearly 50,000 older and disabled residents, Prescription Advantage will no longer pay for part of their premium. The program will continue to assist with coverage once people fall into the so-called “doughnut hole”.
Prescription Advantage enrollees will receive information about the program changes in the next few weeks, including resources to assist them with changing to a Medicare Part D plan that may better suit their needs.
Defining core services for residents is a critical role for the Governor and elected officials. We know that Prescription Advantage is a lifeline for those who rely on the program. We also know that prescription drugs help keep people healthy and out of more expensive care.
Two recent pieces of news on the pharmaceutical and medical device industry:
First, the heavy:
Yesterday, Courthouse News reported that Dr. David Gossman from Leahy Clinic was alleging he was fired for speaking up about ethical concerns.
According to Dr. Gossman, a few doctors at the hospital had worked out an ‘arrangement’ with Medtronic, the worlds largest medical technology company. This arrangement involved the hospital getting access to cutting edge technology so long as they purchased a high enough volume of other devices sold by Medtronic. Additionally, one of these doctors participated in the Medtronics Speaker’s Bureau, using Medtronics information to explain the devices to their peers. Of note, the wife of that same doctor works for Medtronics and owns stock in the company.
Dr. Gossman says that he raised concerns about the ethical boundaries surrounding the purchase of Medtronics devices and soon thereafter was fired. He is seeking damages for defamation and violations of the Massachusetts Whistleblower Act.
We applaud Dr. Gossman for standing up for his convictions and shedding light on a potentially inappropriate industry-provider relationship. Our recently implemented gifts ban and disclosure law provides protections for people like Dr. Gossman, who believe there was an inappropriate interaction. We hope other doctors are not deterred from voicing their concerns about industry interactions.
Citing a new mantra - “Leadership Through Values” - Governor Patrick announced $352 million in cuts to the FY10 state budget this afternoon. He described how he balanced his constitutional duty with his moral values: “Those values include creating good jobs at good wages, offering a world-class education to our kids, delivering quality, affordable health care to our residents, protecting and supporting the most vulnerable – those are the values to which we as a Commonwealth are committed. So as I meet my statutory responsibility to bring the budget in line, I do so according to my moral responsibility to those values.”
The cuts announced today included a $3.5 million reduction in the MassHealth administrative line item; no cuts were made to eligibility or services. In this grim fiscal climate, we applaud the Governor for upholding his commitment to health reform by preserving MassHealth and Commonwealth Care eligibility and services. By preserving MassHealth adult dental benefits, for example, approximately one in ten Massachusetts residents will continue to have access to cost-effective preventive oral health care.
This is not to say that MassHealth is out of the woods for the remainder of FY10, because the agency is operating at a $300 million deficit. The possibility exists for further action in upcoming weeks and months to address the MassHealth shortfall.
In addition to the lack of MassHealth line item cuts, the accompanying legislation proposed a transfer of $30 million from the General Fund to the Medical Security Trust Fund, which pays for medical coverage under the Medical Security Program for unemployed workers. Currently, over 27,000 unemployed individuals and their families in Massachusetts depend on the MSP for affordable health coverage. This transfer will need to be matched with other funding, including adjusting the employer assessment, in order to enable the program to operate next year.
Despite this positive news, there were cuts to many important programs in the Department of Public Health, Department of Mental Health, and in the Executive Office of Elder Affairs. DPH took an $8 million hit and HCFA priorities including the Division of Health Care Quality and Improvement, the Pharmaceutical and Medical Device Marketing Regulation program, and Health Promotion and Disease Prevention were reduced. School-based health, teen pregnancy prevention, and smoking cessation programs were also cut while funding for the primary care workforce development program was eliminated entirely. DMH lost over $10 million in funding, mostly in adult mental health services.
Prescription Advantage was reduced by $5.6 million, likely signaling that premium assistance for low-income Prescription Advantage enrollees will be eliminated. This represents another 14% cut to their budget, after a 30% cut was imposed from FY09 to FY10. AARP noted that Prescription Advantage is a lifeline for thousands of seniors who are struggling to afford their medications. These cuts will surely lead to increases in other costs, as drugs keep seniors health and out of more expensive care.
Cuts will also deeply affect welfare and housing programs for low income people. Some 8,400 families with a disabled member will lose benefits, and 700 families’ grants will be reduced. Homeless shelters will also face cuts. The Mass Budget and Policy Center quickly posted an overview of all the cuts.
Governor Patrick filed this adjusted budget with a request to the legislature to grant him authority to make cuts beyond his branch. Every state manager has been asked to take a 9-day furlough and agency heads have been told to make additional personnel cuts which accounts for $35 million. The Governor remained adamant about not cutting local aid because he feels that local towns and cities have been cut enough. - Suzanne Curry and Jessica Hamilton
Yesterday’s Boston Globe includes a pair of stories on the Mass. pharma industry: one on the doctors who took speakers’ fees from Eli Lilly and the other announcing that Boston is hosting the biggest annual biotech convention. We find it poetic that these two stories are paired up and note that despite great fear of a chill, our gift ban and disclosure law have not brought on an ice age.
Story 1: As Channel 5 (and we) covered last week, as part of a court settlement, Eli Lilly is required to make public disclosure of payments made to physicians, including speakers’ fees paid to doctors who make marketing pitches on behalf of the drug firm. More than 60 Massachusetts doctors were paid some $588,000 for speaking in the first three months of 2009. Boston Medical Center, which restricts their doctors from participating in marketing activities, initially told the Globe that the speeches were OK, since the doctors created their own materials. When confronted with the reality that the industry controls the content (they’re paying for it, after all), BMC reversed itself and ordered the doctors to stop the presentations.
In the article, Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic Foundation, said doctors in speakers bureaus “are actually acting as an agent for the pharmaceutical company. That does create divided loyalties, and universities are realizing the challenges that presents.’’ This echoes our concern with this practice and like many academic medical centers believe that providers serve as a mouth-piece for industry. Lilly’s disclosure of more than 60 Bay State doctors who took speaker’s fees is remarkable and shows the importance of public disclosure of provider-industry interactions.
Story 2: Despite warnings that all was lost, the big Biotech convention is coming back to Boston in 2012. It seems that the Boston Convention Center has somehow overcome the dire circumstances predicted by Robert Coughlin a mere 6 months ago: “At the time, Robert Coughlin, president of the Massachusetts Biotechnology Council, warned that the new rules, which were considered to be the most stringent in the nation, would make event organizers think twice before coming back to Boston.” Instead, biotech jobs have been a major growth area for the Commonwealth.
From the beginning of this debate, we said that (1) the public would learn a lot from the disclosure of payments to physicians, and (2) that requiring disclosure would not unduly hurt pharma business in Massachusetts. Yesterday’s Globe made both those points, beautifully. -Georgia J. Maheras
Massachusetts General Hospital, Brigham and Women’s Hospital, and McLean Hospital - all of which also employ doctors who have received money from Eli Lilly this year - will prohibit their doctors from receiving speakers’ fees from the pharmaceutical industry starting today. Other hospitals in Massachusetts and around the country should follow their lead immediately.
The state, which as of next summer will require drug companies to disclose their speakers and the amounts they are paid, should not stop with transparency. Neither should Congress when it considers a Senate bill that would require such disclosure nationwide. While transparency is a good first step that exposes doctors’ financial relationships to the broader medical community, it is unlikely to affect how patients view their doctors. More important, it will not address the subtle ways the payments influence and interfere with patient care.
Patients trust doctors as stewards of their health. They revere them as scientists who can exercise sound, independent judgment. Allowing doctors to promote drugs for pharmaceutical companies takes advantage of that trust and reverence. It also compromises doctors’ most important work: treating people who are ill.
Now it all comes out. Pharma giant Eli Lilly, required by a court settlement to get ahead of state (and likely to be federal) statutes requiring the disclosure of payments to prescribers, has put their payment database online (see it here). And here comes Channel 5, combing through the hundreds of payments, and skunking out the big Massachusetts names.
And guess what — right now it’s the most read story on their site.
BOSTON — Pharmaceutical companies are paying doctors in Massachusetts and across the country stunning amounts of money, Team 5 Investigates reported Thursday.
Drug manufacturer Eli Lilly recently released a list of doctors paid to do what’s called advising and education. But critics told Team 5 these payments are for nothing more than a sales pitch, and they create a conflict of interest.
“They’re salespeople with MDs after their names,” said Dan Carlat, a Newburyport psychiatrist.
Dr. Brent P. Forester, a Belmont psychiatrist, took in $50,800, and Dr. Stephen C. Ellen, a Bedford psychiatrist, received $50,700 from Eli Lilly alone in just the first three months of this year.
Other top earners included Belmont psychiatrist Dr. Gopinath K. Mallya, who made $38,900, and Dr. Sumer D. Verma, a Lexington psychiatrist who made $36,100 in the first 3 months of 2009.
In the report, expert Dr. Daniel Carlat responded with his personal experience:
Carlat used to be on another drug company’s payroll. “I called myself a drug whore,” Carlat said. “That really is what it feels like when you’re doing it.”
One pharmaceutical company paid Carlat $30,000 for talking to doctors about depression and highlighting a drug made by that company. On his blog, he calls it the “dirty 30,” but said it’s nothing compared to what he said some doctors pocket.
“I personally know of some doctors in the business who have made upwards of one million dollars a year,” Carlat said.
The report also highlights our partners at the Pew Prescription Project, which is working to get a federal disclosure law passed that builds on the Massachusetts law enacted last summer.
The disclosure will allow patients the opportunity to know if their doctor is on the payroll of one or more of the drug companies. We know that aggressive industry marketing of new drugs and devices to doctors through undisclosed gifts, consulting payments, speaking fees, classes, and meals can inappropriately influence medical decisions and create conflicts of interest. Thanks Channel 5 for spreading the sunshine. -Brian Rosman
Next week, the legislature comes back to a packed agenda, which includes the budget and veto overrides. Spending allocations for a number of key accounts was vetoed, and other important priorities were given far less than required due to the dramatic revenue shortfall.
Pfizer to the rescue! Pfizer (which merged with Wyeth in January) will pay $2.3 billion in the “largest health care fraud settlement in the history of the U.S. Justice Department.” The settlement includes a guilty plea for the felony of ‘intent to defraud or mislead’ in addition to the billions paid. This is the latest in a string of settlements (the fourth for Pfizer in the past decade) between pharmaceutical companies and the U.S. Justice Department for kickbacks to doctors and overcharging Medicaid programs (NY Times details here).
According to Tony West, assistant attorney general for the Civil Division: “Illegal conduct and fraud by pharmaceutical companies puts the public health at risk, corrupts medical decisions by health care providers and costs the government billions of dollars. This civil settlement and plea agreement by Pfizer represent yet another example of what penalties will be faced when a pharmaceutical company puts profits ahead of patient welfare.”
The Commonwealth’s share of the settlement $14.7 million. It would be poetic justice to devote the funds Massachusetts receives from this settlement to two critical budget line items that reduce the cost of prescription drugs for the state and low-income residents.
One, Prescription Advantage. This is a state sponsored prescription assistance program for the elderly and some individuals who are disabled. It had 64,000 enrollees in 2008 and the budget cuts caused 14,600 enrollees to lose the prescription drug assistance that keeps our seniors healthy, independent and out of more expensive care.
Two, Academic Detailing. This evidence-based prescription drug outreach and education program takes information learned through comparative effectiveness research on drugs and translates it into practice for health care practitioners. This program is designed to generate health care cost savings for the state. According to an economic model developed by Dr. Avorn and Dr. Soumerai at Harvard Medical School and Brigham and Women’s Hospital, every dollar spent on academic detailing returns, at a minimum, two dollars in drug cost savings. The legislature appropriated $250,000 to keep the program alive, but the Governor vetoed even that small amount.
Putting the proceeds there would honor the source and the intent of the settlement. Thanks, Pfizer. -Georgia Maheras
At last week’s XXII Congress of the International Society on Thrombosis and Haemostasis (note the sponsor logos), held in Boston, 7,500 attendees from over 80 countries learned the latest in scientific findings on important medical issues like gene therapy of hemophilia or thromboprophylaxis as a key patient safety priority.
The attendees also learned about how Massachusetts is in the forefront in preventing the conflicts of interest that interfere with scientific delivery of medical care:
We haven’t talked much about how the pharmaceutical company markets through advertising to providers in academic journals. But a new wide-spread ad highlights the issue with industry funding continuing medical education (CME). This ad counters reports and recommendations from the Institute of Medicine, Medpac and several other authoritative bodies to reduce and eventually eliminate the role of industry funded CME.
Current Psychiatry has been publishing a series of deceptive ads that appear to be patriotic calls for freedom of the press, but which in reality are stealth endorsements of industry-funded CME, paid for by drug companies and medical education companies.
… there are a few paragraphs of gibberish stating that information is important for quality health care (that’s true, that’s why I went to medical school and keep up on the medical literature) and how “Congress and academia are seeking to restrict the content of CME” and how this somehow amounts to “restrictions on how much information consumers and doctors can know about current and new treatments….”
At the end, in small italicized print, we read: “This message is brought to you as a public service by the Coalition for Healthcare Communication.”
To find out who is the “public” benefiting from their “service”, surf on over to their website. It is simply a repository of political ammunition for medical education companies who are on their last ditch stand defending their business model, which depends on getting drug companies, rather than our doctors, to pay for CME.
I am hardly the first physician to be outraged by this stealth ad. Michael Herbert, a primary care doctor and blogger, posted this analysis of the ad that is so nicely written it became an “editor’s pick” of OpenSalon magazine.
Entitling his article “The Secret Defense of CME,” Dr. Herbert concludes his piece thusly:
“Unsurprisingly, this campaign underscores what is wrong with CME funding. You can’t tell where the money is coming from. This makes it difficult to interpret the message, or measure the bias. If Big Pharma and drug marketers can’t defend their CME practices without disguising them in cryptic constitutional arguments, it is hard to see them presenting CME in a way that would allow doctors to clearly evaluate bias.
This is not an ad for freedom of speech. It is an ad for secrecy. And secrecy in a scientific discipline is not a good thing.”
Massachusetts gifts ban and disclosure law put a firewall between industry funding and CMEs. Looks like we put it up just in time. -Georgia Maheras
Today’s the new state fiscal new year, and lots of state laws take effect today. As of July 1st, the pharmaceutical and medical device industries will have to follow Massachusetts’ gifts ban and disclosure law. The text of regulation and FAQs can be found here.
Not all drug and device marketing gifts to prescribers is banned. While pens, mugs and other non-educational gifts are off limits, as are out-of-office meals, these gifts and payments are still allowed:
1. Educational gifts
2. Consulting arrangements
3. Grants
4. Research funding
5. Meals (in-office) that are modest and occasional in nature
6. CME payments that comply with ACCME standards
7. Rebates and discounts
8. Drug and device samples
9. Payments for patient assistance programs
10. Payments and gifts made to charitable organizations
These payments must then be disclosed to the Department of Public Health (DPH) beginning in January, 2010 for the preceding 6 months. DPH will post these documents in an easily accessible place on their website in 2010.
The Globe’s lead editorial today pointed out the holes that still remain, and the need for national action:
While Massachusetts, the sixth state to restrict drug-industry gifts to doctors, has the most comprehensive law, it is far from perfect. Under regulations drawn up by the state Department of Public Health, drug companies will not have to reveal the names of researchers they have paid for participating in company-sponsored clinical trials, although firms will be required to disclose payments for speeches or consulting. The only trials for which disclosure of payments to researchers will be required are for “seeding trials’’ in which the primary intent is to influence sales.
…
Ideally, Congress would require disclosure of all payments, including for research, on a national basis. Lawmakers will be under increasing pressure to take such steps as they deal with reform proposals aimed at both universal coverage and lowering healthcare costs. President Obama sent a signal that prescription practices should owe more to science and less to industry marketing when he called for $1.1 billion in research on the comparative effectiveness of different medications and treatments.
This is the direction in which physicians’ decision making will have to move if healthcare is to remain affordable for individuals and the government. The Massachusetts gift-ban law, flawed as it is, should show the country that it is possible to clean up and make more transparent the links between drug companies and doctors.
As we are poised to implement this law, we want to take some time to contemplate meaning of a gift ban and disclosure law. Industry marketing is pervasive and increases health care costs- study after study has proven this. It can also lead to worse health outcomes as new-to-market drugs have not been tested as heavily as older, generic drugs- again, this is not new information. What is new is that states are now starting to enforce stricter gift ban and disclosure laws. The Physician Payment Sunshine Act is part of the National Health Reform debate- introduced in both the House and Senate.
The message from all fronts is clear: we will no longer tolerate conflicts of interest between patients and doctors. -Georgia Maheras
Petersen talks about deceptive marketing practices, the need for greater federal oversight of drug companies, and offers advice for consumers when talking about prescription drugs with their doctors…just in time for the implementation of our state’s Gifts Ban and Code of Conduct on July 1st.
Here are some of Petersen’s nuggets:
“
It’s hard to overstate how dangerous [pharmaceutical marketing] is, because doctors are supposed to be the gate keepers, they’re supposed to be the independent medical professionals that make sure you don’t get a drug you don’t need, but now most of the doctors in America take money or gifts from the pharmaceutical industry. There was a survey last year that found that nine out of 10 doctors recently had taken gifts or cash from the drug industry and some take hundreds of thousands of dollars a year in consulting fees and speaking fees.
… One day I was at this industry conference. There were a couple dozen pharmaceutical executives giving speeches, and I was looking down the agenda at the speeches that were going to be delivered at this conference, and there was one speech that just really jumped out at me. The speech was entitled “Creating a Disease,” and at that point I didn’t know a drug company would actually create a disease to sell more of a new drug, but I went to that speech and the executive went point by point with his PowerPoint presentation how he and this company had created a new disease. That was pretty shocking.
Question: How have the pharmaceutical companies’ practices led to increased costs in our health system overall?
Answer: It definitely has. This marketing‐driven way of doing healthcare has really contributed to the costs. I think this explains why our healthcare system is broken… The way we pay for healthcare, this fee‐for‐service, it means that patients are getting too many drugs, too many tests, too many surgeries. This explains a lot, this marketing, this aggressive marketing explains a lot of why our healthcare system is broken.
Petersen goes on to describe how the Massachusetts Gifts Ban, in her opinion, does not go far enough and how we need stronger state and federal regulations to control industry marketing.
Download, subscribe and listen here, or read the transcript here. -Georgia Maheras
As Richard Friedman, a professor at Cornell Medical School informs us in a recent New York Times article, pharmaceuticals have positioned many of their more expensive products as “new and sexy blockbuster drugs.” Doctor Friedman discusses an unfortunate trend in doctors and patients creating complex, expensive, and less effective treatment methods, while avoiding time-tested, reliable medications.
After all, why would a doctor give a patient the stodgy Volvo when they can prescribe the sports car? The answer is simple - doctors and patients are hammered with pharmaceutical ads. While these drug ads may not be as in-your-face as those for other products, their effects are extremely powerful. As we’ve long known, another study reported by the New York Times several weeks ago found that even small promotional gifts like pens and coffee mugs can have a profound effect on the way doctors view and use particular drugs.
This is exactly what pharma knows will happen and why they do it. Many physicians, understandably so, believe that they are not susceptible to the drug companies’ efforts. The ads create a cascade of change that may start with a simple choice between two similar drugs, but soon it becomes the difference between the old, reliable, cost effective medication, and the new drug on the block which may not work any better, but comes in what is in effect a shiny new box!
As Doctor Friedman describes:
“I have seen scores of patients in my office, eager to get the latest antidepressant or mood stabilizer that promised them tranquility on their TV screens.”
And patients aren’t the only ones:
“Unlike the public, physicians continue to believe that they are immune to the influence of drug companies, despite strong evidence to the contrary. Studies have shown that doctors with ties to industry are more likely to prescribe a brand-name drug over a cheaper generic version than doctors without such ties.”
Of course, some new drugs offer great medicinal advantages and fewer side-effects. However, many are no more effective to consumers than older, cheaper medicines- they just provide higher profits to their developers. Yet, not much has been published on how newer drugs directly compare to older medications, and in the words of Doctor Friedman, “it is not something drug companies have any interest in discovering.” As Friedman continues, part of the problem rests on outdated FDA approval policies that President Obama is trying to change. In order to gain approval, drugs do not have to outperform older medications. In fact they aren’t even compared. Instead, new medications simply have to outperform placebos.
In Massachusetts, the academic detailing program lets doctors compare new medications with generics. As we discussed here, academic detailing lowers health care costs and increases health care quality. With the help of a few great legislators, we successfully achieved space in the new Senate budget to fund an academic detailing program that would provide doctors with objective, scientific data on the efficacy of medical drugs and devices.
As we see all of these flashy new medications fly by in their hip new commercials, we can’t help but agree with Doctor Friedman’s final words: “I don’t know about you, but I’d opt for an old drug with a known track record of efficacy and safety over an expensive newcomer with no added benefit -any day of the week.” -Brian Schon
These blog posts are so easy. All it takes is a little time to pass.
Excerpt from full page pharma industry Globe ad, August 2008:
“On the Governor’s desk sits legislation that could well determine the future of the life sciences industry in Massachusetts. …
“The chilling effect that this will have on the life sciences industry in Massachusetts could not be more obvious. The impact on thousands of Massachusetts patients desperate for medical hope will be profound. Clinical trials being done today in Massachusetts will most certainly only be available elsewhere tomorrow. The hope for so many patients, suffering so much, will be diminished.”
Boston Business Journal, front-page story, May 22, 2009:
Headline: “Big drug companies hiring steadily
Industry bucking job-cutting trend
“Massachusetts’ strength as a research and biotech capital is spurring several large pharmaceutical companies to expand here even as they shrink elsewhere.
…
“Merck, for instance, plans to double its Massachusetts-based workforce. … AstaZeneca is completing a $100 million expansion of its research facility in Waltham. … Novartis, which already employs 1,500 in Cambridge, is another company adding a division to its Bay State portfolio. … Sanofi-Aventis…has recently been on an acquisition spree and is busily raising its profile in Massachusetts.
Tuesday evening, the Senate matched the House’s approval of a 1.25-cent increase in the sales tax, and agreed to extend the sales tax to alcoholic beverages. We applaud the 29 Senators who voted for the sales tax increase, and congratulate Senators Walsh and Tolman who tirelessly pushed extending the sales tax to alcohol as part of an effort to adequately fund substance abuse programs.
As part of the vote, the Senate leadership distributed a list of budget cut restorations that will paid for by the increased revenue.
The restorations included a number of important health-related priorities of HCFA and our coalition partners:
MassHealth adult dental coverage
MassHealth day habilitation services for disabled
Modest Medicaid rate increases (1.5% for managed care; .5% for hospitals; 1.5% for physicians)
Medicaid medical home pilot projects
Elder home care
Prescription Advantage benefits ($10 million of the $15 cut compared to the House level)
Rosie D - Medicaid benefits for severely mentally ill children
Adult and children’s mental health
Primary care loan forgiveness
Academic detailing
DPH programs, including Substance Abuse, AIDS, Community Health Centers, Suicide Prevention
More details and confirmation of the Senate’s intention will come when we see the actual amendment language. We are grateful for the Senate’s inclusion of these critical health programs in the restoration package.
One key priority not included in the list is restoring coverage to 28,000 Commonwealth Care enrollees who would lose coverage under the Senate budget. We call on the Senate to restore their coverage during the rest of the budget debate.
When the Department of Public Health implemented the Massachusetts gifts ban and disclosure regulations, our law was considered the strictest in the nation.
But a Vermont law passed at the end of thier legislative session bans all gifts except for samples, reimbursement for reasonable work, demonstration units, rebates, scholarships for medical students, genuine educational material such as journals.
The law allows ‘payments’ to providers that includes specific Continuing Medical Education (CME) funding requirements, bona fide research, royalties and licensing fees, and honoraria. The companies have to report payments made for everything except: royalties and licensing fees, rebates and discounts, and payments for clinical trials. Industry must also provide information on all drug samples distributed. This legislation also creates a work group to recommend a sample list and a process for substitution for consideration - along the lines of therapeutic substitution to promote increased use of generic drugs. And one more thing- each violation of the law can cost up to $10,000 in penalties- double the Massachusetts’ penalty.
First, please watch the video below, highlights from today’s inspirational, packed “Stop The Cuts” rally at the State House. The speakers include Harris Gruman of SEIU and the Stop the Cuts Coalition; Lisa Wong, Mayor of Fitchburg; John Bennett of Mass Senior Action; and Lynn Norris of Neighbor to Neighbor.
Next, call your State Senator (not sure who that is? look it up here) and urge him or her to support expanded revenues and HCFA’s key budget amendments to restore critical health care programs. The Senate will be starting its budget debate on Tuesday.
Adult Dental Benefits (Amendment EHS 473)
Senator Chandler
Eliminating adult dental benefits from MassHealth and Commonwealth Care will affect nearly 800,000 individuals throughout the state. Oral health is a critical part of overall health - studies show that chronic oral infections are associated with complex health problems such as heart disease, stroke, diabetes, low-birth weight, and premature infant births. Approximately one-ninth of Massachusetts’ population will be affected by this cut, including more than 120,000 low-income seniors and 180,000 disabled individuals on MassHealth and 91,000 individuals on Commonwealth Care.
Commonwealth Care Coverage (Amendment EHS 656)
Senator Chang-Diaz
Some 28,000 “special status” legal immigrant adults are enrolled in Commonwealth Care. They pay sliding-scale premiums, and are enrolled in private managed care plans. Coverage for this group, whose health needs was previously covered by episodic coverage via the Uncompensated Care Pool, was a provision of health reform. Ending eligibility for special status immigrants will leave over 28,000 Massachusetts residents without the comprehensive health coverage they need, and increase costs in other programs.
Office of Oral Health (Amendment EHS 465)
Senator Chandler
Line item 4512-0500
This amendment will provide equitable funding the Department of Public Health’s Office of Oral Health to bring needed oral health education and care to children and adults in underserved parts of the state, including dental care for persons with disabilities.
Child and Adolescent Mental Health Services (Amendment EHS 500)
Senator Spilka
Line item 5042-5000
This amendment restores funding to the primary account under the Department of Mental Health that provides services to children and young people with behavioral health needs. Included in this line item is funding for the Massachusetts Child Psychiatric Access Project, a model program that provides mental health consultations to pediatricians.
Office of Health Equity (Amendments EHS 597 and EHS 690)
Senator Fargo
Line item 4000-0300
These amendments add language to maintain the Office of Health Equity in the Executive Office of Health and Human Services. The Office of Health Equity oversees comprehensive efforts to eliminate health disparities, providing leadership and coordination of all state agency efforts. The Office is developing interagency disparities initiatives, preparing an annual health disparities report card, and evaluating the effectiveness of interventions.
Children’s Medical Security Plan (Amendment EHS 621)
Senator Eldridge
Outside Section
This amendment standardizes administration of the Children’s Medical Security Plan (CMSP), to bring the program into line with other programs administered by MassHealth. Additionally, it gives EHS the option to reexamine benefits offered under CMSP and to eliminate unrealistic caps on services (such as the currently-mandated $200 annual cap on prescription drugs for children).
DEEC Consultative Mental Health Services (Amendment EHS 617)
Senator Flanagan
Line item 3000-6075
This amendment restores the line item and funding for mental health consultative services to preschools. Massachusetts ranks 9th nationally for the rate of expelling young children from early education settings. Providing behavioral health consultative services has been shown to reduce the rate of expulsions and to reduce special education costs for children the following year in kindergarten.
DPH Quality Programs (Amendment EHS 686)
Senator Fargo
Line item 4510-0710
Last year Massachusetts made huge strides in improving the quality of health care in the Commonwealth by passing Chapter 305. Among its important duties, the Division of Health Care Quality gathers information and issues reports on Serious Reportable Events and infections to help hospitals improve the delivery of health care and save lives. Proposed cuts would slash this program.
Prescription Advantage (Amendment EHS 697)
Senator Montigny
Line Item 9110-1455
This is a state sponsored prescription assistance program for the elderly and some individuals who are disabled. It currently has 64,000 enrollees and this cut will cause 14,600 enrollees to lose their prescription drug assistance that keeps our seniors healthy, independent and out of more expensive care.
FMAP Transparency (Amendment EHS 700)
Senator Montigny
The United States federal government’s economic stimulus package will give states additional money for urgent health care needs. The enhanced Federal Medical Assistance Percentage (FMAP) funds are intended to be invested in MassHealth, health care, and public health. This amendment creates an identifiable, transparent FMAP fund to: secure jobs; maintain health care reform’s achievements; protect essential safety net services; preserve funding for our hospitals and community health centers; and fund cost-effective public health initiatives.
Evidence-based outreach and education program (Amendment EHS 702)
Senator Montigny
Line item 4510-0716
The evidence-based outreach and education program, also referred to as “Academic Detailing” would provide doctors with unbiased evidence to guide them in their prescribing decisions. Such programs have demonstrated to provide immediate savings that far exceed the cost of the program. This amendment restores this cost-saving program.
A detailed list of HCFA-supported amendments are here.
Yesterday, Senator Richard Moore and Representative Harriett Stanley hosted a briefing on the Massachusetts Academic Detailing program.
The House restored funding for this program on the floor, and Senator Montigny will be filing an amendment to restore funds in the Senate budget.
Dr. Jerry Avorn presented an overview of the program emphasizing that this program teaches doctors about the safety, cost and efficacy of drugs and other treatments for specific conditions. Senator Moore then discussed how academic detailing is part of the next steps in achieving higher quality, lower cost health care. Senator Moore also joked that we should figure out a way to get PhRMA to pay for the academic detailing program, which caused most of the room to laugh (not quite sure why the industry lobbyists didn’t laugh…).
The Senator then turned the floor over to two doctors who acted out a detailing visit on the topic of Type II Diabetes. After the role play, Dr. Avorn opened the room up to questions. The first question, by Rep. Lewis, was about how the ‘detailers’ balanced their message to the clinicians: They talk about cost savings, but also about efficacy- how do they get it right? The response was that the message is solely around efficacy and appropriate care for patients. While evidence on cost is presented, the detailers focus on the best care. Many times the lowest cost medication with the longest track record (examples given were aspirin and other generics that have been around for decades) are proven safe and effective.
Dr. Avorn and the other doctors fielded great questions from Rep. Hecht and Senator Montigny as well as a ‘lay person’ question from one of our friends in the biotech industry (for details on the Q&A check out our tweets: http://twitter.com/hcfa.) Dr. Avorn concluded by saying that his hope was to make the industry drug reps irrelevant.
For those who could not attend, the Daily Show clip featuring Dr. Avorn explains why academic detailing is so important:
