E N D
1. Righting the Script: Improving Prescription Drug Policy in an Era of Health Reform December 9, 2008 Peter Wyckoff, National Consultant, The Prescription Project
Dr. Rupin Thakkar, Washington Coalition for Prescription Integrity
Alicia Haywood, Colorado Prescription Drug Coalition
2. Coalitions and Alliances: Building a Prescription Reform Coalition The Washington State Coalition – a leader perspective – Rupin Thakkar
The Colorado State Coalition – A staffing perspective - Alicia Haywood
Additional State Models & Coalitional Issues - Pete Wyckoff 2
3. The Prescription Project 2008 Annual MeetingState Policy And ActionCase Study: Washington Coalition for Prescribing Integrity Rupin Thakkar, MD
Co-Chair, WA Coalition for Prescribing Integrity
Board of Directors, National Physicians Alliance
4. National Physicians Alliance Founded in 2005 to restore physicians' primary emphasis on the core values of our profession: service, integrity, and advocacy.
Physicians must partner with patients in order to achieve healthcare reform. The needs of patients and communities should be the highest priority.
Governance structure includes the Council of Consumers- participates in the creation and review of NPA’s policies.
Unbranded Doctor Campaign: Refuse all financial entanglements with the drug industry and seek only evidence-based sources for drug information.
5. Rx Data-mining 3 WA docs interested in promoting NPA’s Rx reform proposals at state level…HB 1850, 2007 session, “The Prescription Privacy Act”- failed in cmte.
NPA’s position paper on data-mining led to front-page story in Washington Post.
RxP informed us of state-based grants and their interest in WA state.
6. A History of Progressive Rx Reforms in Washington Early 1980’s: Therapeutic Drug Substitution Act
2003 Evidence-based Prescription Drug Program and State Preferred Drug List
2004 Pooled Purchasing Act/Rx Card
70,000 people covered, avg discount 30-60% off medications
2005-2007 Several hospitals and clinics ban drug reps from their campuses
2007: Puget Sound Health Alliance encourages doctors to refuse gifts & samples
7. Building Coalitions Primary Goal: When organizations join together they can produce change that they may not be able to deliver individually. They can pool resources, expand their power base, and raise their volume to decision-makers.
Secondary Goal: If groups that traditionally have not worked together learn to respect each other’s differences and experience the exciting process of teaming up to achieve a common goal, the coalition can create a lasting base for change. In our case we hoped to spur future partnerships for broader healthcare reform.
8. Criteria for member selection Credible and reputable member of the community
Be committed to the coalition’s mission and objectives (sign-on statement)
Politically active / strong links with the community and with decision-makers (asked to prioritize issue in their agenda and earmark lobbyists’ time to the issue)
9. WA Coalition for Prescribing Integrity
Mission
Promote professional and policy change that will: increase evidence-based prescribing in the state of Washington; reduce conflicts of interest between Washington prescribers and the pharmaceutical industry; preserve the privacy of the doctor-patient relationship; and ensure that all patients in our state have access to quality, appropriate, and affordable medicines.
10. WCPI Objectives Educate consumers, healthcare providers, and policy-makers about how and why pharmaceutical marketing drives up the costs of healthcare.
Increase awareness of marketing tactics used to promote medicines, and highlight why conflicts of interest often result in increased prescribing of newer, more expensive drugs without proven benefits in terms of efficacy or safety over older or generic alternatives.
Educate consumers, healthcare providers, and policy-makers about why commercial use of prescription data increases healthcare costs and can reduce the quality and safety of prescribing.
Work to ensure the privacy of patients’ prescription records, and prohibit interference by the pharmaceutical industry into the private doctor-patient relationship.
Work to ensure that Washingtonians have access to the prescription medicines that they need at prices they can afford.
Promote educational opportunities for healthcare providers that promote evidence-based prescribing.
11. WCPI Members Doctors:
National Physicians Alliance, Puget Sound
WA Chapter, American Academy of Pediatrics
King County Academy of Family Physicians
WA Academy of Family Physicians
Physicians for a National Health Program- WA
King County Medical Society
WA State Medical Association
12. WCPI Members Consumers:
WA Community Action Network
AARP- Washington
League of Women Voters
SEIU 1199
WA State Labor Council
Healthy WA Coalition
Large coalition of consumer, labor, faith and business groups seeking to ensure affordable, quality healthcare for all Washingtonians
13. WCPI Members Other Key Stakeholders:
Group Health Cooperative
WA State Pharmacy Association
14. WCPI Governing Structure Director- only staffperson
2 Co-Chairs (founders)
Steering Committee- reps from 6 organizations who were willing to make the largest commitment of time and resources and helped with outreach to other potential members
While all appointed, at first meeting of full coalition asked for vote of approval
15. Use of grant funds Staff expenses (salary, travel)
Meeting expenses (space, parking, refreshments)
PR Firm
Logo, letterhead, business cards
Fact sheet, Common Myths, Talking Points
Earned Media
16. WCPI Earned Media Public Radio
Coverage of Senate Hearing, 1/17/08
Op-EDs:
“Give Doctors & Patients Privacy,” Seattle Post Intelligencer, 2/7/08
Support Bill to Halt Drug-Record Mining, Bellingham Herald, 2/21/08
Editorials:
“Data-Mining should get the shaft,” The Seattle Times, 2/25/08
“Opening Eyes,” Spokane Spokesman Review, 2/22/08
Articles
The Olympian, 1/22/08 & 2/25/08
Tacoma News Tribune, 2/26/08
17. Legislative outcomes HB 2664/SB 6241, “Prescription Privacy Act” (Datamining) Prohibits the sale or use of prescriber’s identifiable prescription data for marketing or promotional purposes.
Governor’s endorsement
Passes state senate (26-22)
Fails by 1-2 votes to make floor of State House
Gifts Disclousre: Fails to pass out of committee in both house & senate
Academic Detailing Program: Fails to pass out of committee in both house & senate
18. Accomplishments Education:
Professional Societies
Publications (FABLES- Journal of WCAAP, WA Family Physician)
Presentations (WSMA, WCAAP, WAFP, KCAFP, KCMS, PNHP)
Action alerts to members throughout session
Policy-Makers
State Senate Consumer Protection hearing (Nov ‘07)
House and Senate Health Committee hearings (Jan ‘08)
Follow-up education during off session
Public
Coalition Materials
Earned media
19. Accomplishments Change:
Professional
Clinics banned drug detailers
Doctors register with PDRP. KCAFP: Opt-Out Day
WAFP holds 1st “Pharm-Free” annual meeting
Patient/Consumer
“Newer is not better” and “The Unbranded Doctor”
Consumer Reports Best Buy Drugs
20. Accomplishments Building a base for broader healthcare reform:
Before WCPI no physician organizations belonged to the Healthy WA Coalition (state’s largest group dedicated to healthcare reform). Now NPA-Puget Sound and WSMA are active members.
Governor Gregoire & Rep Pedersen vocalized that the data-mining bill was a necessary step towards reducing costs and improving quality so that we can cover all Washingtonians
21. Future plans of WCPI Continued outreach / educational efforts
Expand membership. Wish list:
Clinics & Hospitals
Non-Physician Prescribers (i.e. NPs, PAs)
Legislative activism
Protect Patient Privacy
Close loophole in HIPAA that allows patient’s private prescription histories to be sold for use in direct marketing
Enable Academic Detailing
Mandate state to apply for federal funding for the development of a program if they become available with passage of S3396: "The Independent Drug Education and Outreach Act "
22. Contact Us: Rupin Thakkar, MD
Co-Chair, WA Coalition for Prescribing Integrity
Email: rupin.thakkar@npalliance.net
Joana Ramos, MSW
Director, WA Coalition for Prescribing Integrity
Email: warxreform@gmail.com
Thanks to my co-chair, Jeff Huebner, MD, our tireless coalition, The National Physicians Alliance, and The Prescription Project
24. Colorado Prescription Coalition Origin
The Process
Challenges
Strengths
Results
25. Results 2009 Legislative Session
Data Mining
Conflict of Interest
2009 Pilot Program
Academic Detailing
26. RxP Coalitions and Technical Assistance Massachusetts
Minnesota
Maryland
Wisconsin
Technical Assistance
Maine
Vermont
New Hampshire
D.C.
New York
New Mexico 26
27. Keys to Success Broad Coalition
Active Issues with Buy-In of Stakeholders
Role of state RxP coalitions in national health reform effort
Media Strategies
Funding & Support - RxP Reform Campaigns 27
28. Massachusetts Prescription Reform Coalition Diverse group of community organizations, local and national non-profit organizations, healthcare advocates, private insurers, and healthcare providers dedicated to making affordable prescription drugs available to everyone.
AARP Massachusetts; AIDS Action Committee; Blue Cross Blue Shield of Massachusetts; Commonwealth Care Alliance; Commonwealth of Massachusetts Group Insurance Commission Community Partners; Health Care For All; Leukemia and Lymphoma Society of Massachusetts; Massachusetts Council on Aging; Massachusetts Senior Action Council; MASSPIRG; National Physicians Alliance; Neighborhood Health Plan; The Prescription Project; United Auto Workers, Massachusetts State Community Action Program Council
28
29. Massachusetts Prescription Reform Coalition – Compelling story The Coalition is committed to promoting evidence-based, unbiased prescribing.
Why We Have Come Together
Massachusetts’ healthcare access expansion can only be maintained if healthcare costs are controlled.
The cost of prescription drugs is among the fastest growing segments of health care spending.
Between 2000 and 2007 the price of many of the most commonly prescribed brand name drugs rose by nearly 50%, far exceeding inflation.
These rising costs threaten the stability of health care reform and the Commonwealth’s budget.
The costs also threaten people's ability to access the medications that they need to maintain their health.
29
30. Massachusetts Prescription Reform Coalition Mass Prescription Drug Legislation
Comprehensive cost and quality legislation
Academic Detailing
Gifts Code of Conduct and disclosure– (transparency & ban)
The Message
The Coalition is joining with state leaders to highlight the importance of taking action against pharmaceutical industry marketing practices that contribute to high and rising prescription drug costs, threatening the success of Massachusetts health reform.
The end goal of this Coalition is to ensure that all people are able to afford the medications that they need to maintain their health.
30
31. Maryland Led by the Health Care for All
Part of broader Maryland Coalition on Comprehensive Health Care Reform
Working on Academic Detailing
31
32. Minnesota Led by the Minnesota Senior Federation
Coalitional efforts around evidenced based prescribing began in 2005
Consumer Reports Best Buy Drugs
Neurontin Settlement – Attorney General Consumer & Prescriber Education Grant Program
32
33. 33
34. 34
35. Minnesota RxP Coalition Began in 2007
Around key issues
Data Mining
Strengthening Minnesota Pharmaceutical Gift Ban Legislation
PBM Transparency Legislation
Academic Detailing
35
36. “Drug Companies influence should worry public, docs” “We are adamant that a physician's recommendation to a patient must reflect best medical evidence and be without influence from his or her relationship with a drug company.”
36 Physician Leadership Policy Forum, a group of physician leaders from Allina Hospitals and Clinics, Children's Hospitals and Clinics, HealthEast, HealthPartners, Hennepin Faculty Associates, Fairview Health Services, North Memorial Medical Center , Park Nicollet Health Services and University of Minnesota Physicians
Physician Leadership Policy Forum, a group of physician leaders from Allina Hospitals and Clinics, Children's Hospitals and Clinics, HealthEast, HealthPartners, Hennepin Faculty Associates, Fairview Health Services, North Memorial Medical Center , Park Nicollet Health Services and University of Minnesota Physicians
37. “Drug Companies influence should worry public, docs” Minnesota Physician Leadership Policy Forum
Member organizations are:
Requiring physicians to disclose conflicts of interest and income from industry relationships and in some cases seek prior approval for industry relationships.
Prohibited or restricted the longstanding practice of pharmaceutical "sampling" (handing out free drug samples) within our facilities.
Other steps
37 Physician Leadership Policy Forum, a group of physician leaders from Allina Hospitals and Clinics, Children's Hospitals and Clinics, HealthEast, HealthPartners, Hennepin Faculty Associates, Fairview Health Services, North Memorial Medical Center , Park Nicollet Health Services and University of Minnesota Physicians
Physician Leadership Policy Forum, a group of physician leaders from Allina Hospitals and Clinics, Children's Hospitals and Clinics, HealthEast, HealthPartners, Hennepin Faculty Associates, Fairview Health Services, North Memorial Medical Center , Park Nicollet Health Services and University of Minnesota Physicians
38. Combating Marketing to Doctors 38
39. Minn. Health System Purges Its Buildings of Drug Company Trinkets “baubales,
bangles and
beads”
39
40. Combating Marketing to Doctors 40
41. Dr. Kenneth Irons, MD - Chief of
community clinics for SMDC… 41 Minn. Health System Purges Its Buildings of Drug Company Trinkets
42. Minnesota RxP Coalition RxP Funding ended in Sept 2008 – RxP Technical support continues
Organizing Issues
MN State Senate Interim Hearing -Friday, December 12th
Gift Ban Expansion
Academic Detailing
42
43. Wisconsin Became RxP project in Fall of 2008
Led by the Coalition of Wisconsin Aging Groups
Major 2009 issues will be Academic Detailing
Broadest potential coalition in the country
29 groups currently considering membership
Medical and Hospital Organizations
Labor and Consumer Organizations
Business Organizations
Insurers and Payers
43
44. Wisconsin – Potential Coalition Members Medical & Pharmaceutical Organizations
Wisconsin Medical Society
Wisconsin Nurses Association
Pharmacy Society of Wisconsin
UW Population Health Services 44
45. Wisconsin – Potential Coalition Members Consumer Organizations
Coalition of Wisconsin Aging Groups (CWAG)
Citizen Action Wisconsin
Wisconsin State AFL-CIO
Wisconsin Education Association (WEA)
Wisconsin Retired Educators Association
Wisconsin Farm Bureau
Milwaukee Committee on Aging
AARP 45
46. Wisconsin – Potential Coalition Members Health Plans & Systems & Payers
Aurora Health Care
United Health Care - WI
Humana - WI
Marshfield Clinic
Dean
WPS Insurance
Wisconsin Association of Health Plans
Hospitals Groups
Ministry Health Care
Wisconsin Health and Hospital Association
Medical College of Wisconsin
UW Hospital and Clinic
46
47. Wisconsin – Potential Coalition Members Other Stakeholder Organizations
The Alliance – “Employers moving healthcare forward”
Fond du Lac Area Businesses on Health (FABOH)
Wisconsin Collaborative for Healthcare Quality (WCHQ)
Wisconsin Association of Healthcare Underwriters
Rural Wisconsin Health Cooperative
Nation Federation of Independent Businesses – Wisconsin (NFIB)
Milwaukee County Committee on Aging
Brodrick/Barr Lab (Generic drug manufacturer)
Trust Wisconsin Catholic Conference
Wisconsin Education Association Trust (WEA Trust) 47
48. RxP Technical Support Technical Assistance
Maine
Vermont
New Hampshire
D.C.
New York
New Mexico
West Virginia
48
49. Keys to Success Broad Coalition
Active Issues with Buy-In of Stakeholders
Role of state RxP coalitions in national health reform effort
Media Strategies
Funding & Support - RxP Reform Campaigns 49
50. Media Strategy and Outreach Key vehicle for delivering your message to stakeholders and for galvanizing support
Have an objective and a strategy
Objective is to place 3 favorable stories in 2 key print and one radio media outlet
Strategy is to announce filing of legislation at State House press conference
Before you start: What’s the story – the hook?
Timeliness, local and/or human interest angle, conflict/crisis, relevant within context of other big news, relevant to publication’s audience (trade vs. mainstream press)
What isn’t news
50
51. Media Strategy – First Steps: Identify a primary spokesperson
Develop key messages and train spokesperson; repeat, repeat, repeat
Identify appropriate type of media (print, TV, radio, online, dailies, weeklies)
Do your homework: identify appropriate reporters
Proactive tactics proactive: press releases, media alerts for events, op-eds, ed board meetings, story pitching for hard news and features, reporter touch base
Reactive tactics: statements, op-eds, Ed Board, letters to the editor, story pitching
51
52. How to use press to advance the campaign: Engage coalition members in outreach
Engage legislators in outreach (use quotes, co-author op-eds, joint ed board meetings)
Disseminate positive press coverage to legislators (State House drops)
52
53. Funding and Support for RxP Reform Campaigns Technical Assistance
The Rx Project & Community Catalyst
NLARX – National Legislative Association on Prescription Drug Prices - www.reducedrugprices.org
PPC – Prescription Policy Choices - www.policychoices.org
National funding efforts & coordination
Goal: leverage and support state work
Local Funders
Local & State Stakeholders
53
54. Righting the Script: Improving Prescription Drug Policy in an Era of Health Reform December 9, 2008 Peter Wyckoff, National Consultant, The Prescription Project
Dr. Rupin Thakkar, Washington Coalition for Prescription Integrity
Alicia Haywood, Colorado Prescription Drug Coalition