Declaring doctor payments
pharmafile | December 16, 2008 | Feature | Research and Development, Sales and Marketing |Â Â ABPI, EFPIA, Europe, UK, US, ethics, industry relations, paymentsÂ
A number of pharmaceutical companies in the US have recently announced they will declare all the payments to healthcare professionals. It sounds like an inspiring leap towards transparency, but is it really such an innovative or admirable step?
Cynics would say the companies involved are simply more media savvy than their industry competitors – that rather than breaking new ground, they are simply grabbing the chance of headlines to boost their corporate social responsibility.
It's would be a harsh assessment, and yet in the UK the practice is virtually enshrined in the ABPI's Code of Practice. The industry body led the pharma world in 2006 by insisting that companies operating in the UK had to declare which patient groups they were supporting. This year the ABPI's lead was followed by its EFPIA, its European counterpart, which required similar declarations to be written into all national codes, prompting peals of anguish across the region. However, the European requirement went further and, instead of just publishing a list of supported patient groups, companies were required to provide brief details of the support provided. Not the amounts, just the 'nature' of the support.
Elsewhere in the EFPIA Code, later adopted by the ABPI as a member of EFPIA, were 'encouragements' to consider regarding both payments made for services provided by healthcare professionals and also grants made to healthcare organisations.
Where grants to organisations are concerned, companies are 'encouraged' to 'make available publicly' information about the support they provide. And of course, it has long been a requirement of the EFPIA and ABPI Codes that all activities, materials and meetings arising from industry support should bear declarations of pharma's involvement.
What may not be so widely realised is that some NHS trusts now publish lists of donations they receive. In fact the NHS was the source of information used in the latest round of concerns raised by Consumers International when they issued a report about pharma sponsorship for certain hospital departments and NHS employees in the autumn of last year. And, of course, the Freedom of Information Act means that anyone can ask for a list of donors to hospitals and the NHS has to respond because it is a government institution.
However, the aspirations to transparency are being driven at the highest international level, with the International Federation of Pharmaceutical Manufacturers (IFPMA) introducing the requirement for written agreements for consultants back in 2006. EFPIA built on this requirement and introduced a new twist. Within the written agreement (that's a contract to me and you) was a requirement that the consultant declare they are being paid when speaking at events, writing articles, etc. Most of pharma's consultant contracts already include a relevant clause.
Educational sponsorship for individuals, however is not currently subject to the requirements for transparency declarations of any kind. Indeed it is a bizarre anomaly that the payment that most closely resembles a 'gift' of money (albeit for a worthy purpose) is not subject to any documentary controls at all. That said the majority of companies are already implementing the need for written agreements when providing travel grants, etc. This is not really a surprise. Every time that money changes hands, companies must be wary of anti-bribery legislation. In particular the impact and reach of the US Foreign and Corrupt Practices Act – which has so far not fully flexed its considerable muscles.
It would be a brave firm that had a sister-company in the US and failed to maintain basic standards of documentation regarding financial transactions with government officials (which in the UK includes just about every healthcare professional!).
Prediction time
The next revisions to the ABPI Code are perhaps 12 months away. When they arrive, expect those areas that 'encourage' or 'strongly encourage' transparency to become mandatory. In other words, companies will probably be expected to publish lists of the healthcare organisations to which they give support and financial grants. The Code of Practice watchdog the PMCPA currently says that only support to the value of £500 or more needs to be declared where patient groups are concerned, so expect a similar level to apply here – which basically means all institutional grants. It will almost certainly apply to GP practices, including single-handed GPs.
Will we have to publish the nature of the support and the amounts involved? Well, that seems to be a reasonable assumption. And if we don't need to publish the amounts this time round, then I would bet my house on it being in the 2011 ABPI Code.
But back to next year, and companies should expect to have to announce the amounts of money they give to patient groups. Some already do this – GSK's policy is probably 'best practice' in this area. A good amount of information is given on the patient group section of their website, even though the page itself is a little hard to locate.
What about payments made for services received? There may be a number of issues for the lawyers to consider here, regarding the fact that these are commercial arrangements and therefore some aspects of competition law could conceivably prevent pharma companies from declaring the amounts they pay. Certainly, the service providers will not want their charges to be published to their competitors (other speakers). And if one regards the payment as personal income, then there may be data privacy issues to consider too. Even the NHS only publishes the bandings of salary scales – not the amounts paid to individual employees.
And so we return to the anomaly that is travel grants. It would be astonishing if, in 2009, some controls were not introduced in this area. So expect a requirement for written agreements and probably 'encouragement' to publish list of recipients of support.
Finally – a question: if a company ignores 'strong encouragement' would it have to defend their rationale if a complaint arose? Answers by email please.
Related Links:
Lilly to reveal doctor payments
Steven Gray is a chartered marketer and former compliance officer who specialises in providing business-friendly compliance services to the pharmaceutical industry. For further information, visit www.stevengrayconsulting.co.uk.
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