Jeff Huebner, MD Co-Chair, Coalition for Prescribing Integrity

1. Families USA National MeetingJanuary 25th, 2008Case Study: Washington State Coalition for Prescribing Integrity Jeff Huebner, MD Co-Chair, Coalition for Prescribing Integrity Founding Member, National Physicians Alliance Families USA Intern, 1997

2. Rx Marketing to Doctors Industry spends $7 billion/year on drug marketing to MDs ($13,000/MD) 90,000 sales reps (1 for every 5 MDs) 2007 survey in NEJM found 94% of doctors have industry relationship Includes gifts, lunches, trips, educational grants, entertainment, free samples 2

3. My Perspective a bit different… AMSA “Pharm-Free” Campaign and NoFreeLunch.org University of Washington Family Medicine Residency Community Health Centers of King County Must constantly think about issues of cost for my patients Moving toward a “Pharm-free” environment

4. Our Genesis • National Physicians Alliance, new physicians’ organization dedicated to restoring the core values of the profession: service, integrity, and advocacy • The Prescription Project • Washington State House Bill 1850, 2007 session, “The Prescription Privacy Act” • Puget Sound Health Alliance (no drug reps, no drug samples) • WA State Blue Ribbon Commission

5. Combating Marketing to Doctors

6. A History of Progressive Rx Reforms in Washington 1970’s Pharmacy Practice Act Early 1980’s Therapeutic Drug Substitution Act 2003 Evidence-based Prescription Drug Program and State Preferred Drug List (requires state agencies to join, private sector may join in) 2004 Pooled Purchasing Act/Rx Card 70,000 people covered, avg discount 30-60% off medications 2007-08 House Bill 2664/Senate Bill 6241 “Prescription Privacy Act” (data-mining)

7. Coalition for Prescribing Integrity • Initially formed in early 2007 founders included NPA Puget Sound, King Co Medical Society/Family Physicians, WA Community Action • Spring meetings with The Prescription Project • Recruitment of larger coalition with steering committee

8. WA Coalition for Prescribing Integrity WORKPLAN 2007-08 Promote policy change (policy-makers), professional change (health professionals), and patient/consumer education (public) Educate about how Rx marketing tactics increase costs and sometimes compromises best care practices and/or safety ***Education about the commercial/marketing use of physicians’ prescribing data (ie data-mining) Education about the problems with gift-giving by the pharmaceutical industry to prescribers Determining future interests of the coalition such as promotion of clinical trials registry or academic professional education program

9. WA Coalition for Prescribing Integrity Elevator Statement: We support policy and professional change that will preserve privacy of the patient-doctor relationship and ensure patient access to appropriate and affordable prescription drugs.

10. WA Coalition for Prescribing Integrity NPA Puget Sound Health Security Coalition AARP Washington Healthy WA Coalition King Cty Med Society King Cty Family Physicians Group Health Cooperative League of Women Voters Northwest Health Law Advocates Physicians for a National Health Program SEIU 1199 WA Academy of Family Phyisicians WA CAN (Cmty Action Network) WA Chapter of Amer Acad of Pediatrics WA State Labor Council WA State Medical Society WA State Pharmacy Association

11. Accomplishments • Formation of large coalition with funding from the Prescription Project, led by a steering committee and dedicated to at least a 2 year workplan • Education and Activism within Professional Societies locally to discuss the conflicts of interest and potential harms of data-mining and gifts, while developing plans for alternative/unbiased education • Professional journals • Meetings • Action alerts to members • Education of Policy-Makers • State Senate Consumer Protection hearing • Recent House and Senate Health Committee hearings • Follow-up education • PR Plan/Earned Media • Physicians’ speakers list • Public radio, The Seattle Times, The Olympian • Other possibilities in Tacoma, Bellingham, Yakima, Spokane

12. Northwest News/Public Radio Coverage of Senate Hearing 1/17/08 “Nibbling at the edges of health care.” Seattle Times op-ed 1/21/08 “Lawmakers pushed to stop pharmaceutical ‘data-mining’” The Olympian 1/22/08

13. Accomplishments • HB 2664, “Prescription Privacy Act,” Prohibits the sale or use of prescriber’s identifiable prescription data for marketing or promotional purposes. • HB 2680, “Disclosure of Gifts,” Requires every pharmaceutical manufacturer to report every gift, fee, or payment made to health professionals, etc” • HB 2694, “Rx Professional Education,” Creates a prescription drug professional education program in the Health Care Authority (for profs in state-purchased progs)

14. Accomplishments • Professional Change • Group Health, the Everett Clinic, Polyclinic…policies expanding to CHCKC and others • State medical journal articles • KCAFP PDRP Opt-Out Day • WAFP “Pharm-Free” policy • Patient/Consumer Change • “Newer is not better” • Consumer Reports Best Buy Drugs • True partnerships in patient-doctor relationship

15. The Story of Medicine • History of medical society activism…often absent, but opportunity for them to work together on something good for patients and reducing health care costs, and offers opportunity to assist with professional change • Do not tell, ask for help and respond to their needs • Find dedicated leaders • NPA/Pediatrics/Family Physicians • KingCoAFP and King Co Med Society • Resolution to WAFP -> Resolution to WSMA • WSMA involvement has been crucial • Professional voice to help counter pharmaceutical lobbying • Usually friendly with legislative opponents

16. Other Lessons…Opponents’ Arguments • “This is education, not marketing” • Clinical pharmacists, The Medical Letter, Pharm-free CME, journal articles • “Actually, costs will increase” • They mean marketing costs, not overall drug costs or health system costs • AMA’s Prescription Data Restriction Program “PDRP” • Most doctors don’t know they’re being data-mined, let alone that this program exists • Only 1 of 3 doctors belongs to the AMA • Data still given to the drug companies, supposedly not the reps. • Voluntary and not enforceable • IMS/Data-mining lists available and used by academic researchers • Actually costs are exhorbitant and not worth public subsidy

17. The Relationship to Our Work for Universal Access Health Washington Coalition - includes consumer, labor, and faith groups seeking to ensure affordable, quality health care for all Washingtonians Six months ago no medical group members Now NPA-Puget Sound and WSMA aboard Prescription Privacy a top priority of their robust 2008 legislative agenda Governor Gregoire dedicated to goal of reducing costs and improving quality so we can cover all Washingtonians

18. Contact Us: Jeff Huebner, MD Co-Chair, WA Coalition for Prescribing Integrity Email: huebner.jeff@gmail.com Art Zoloth, Pharm.D Executive Director, WA Coalition for Prescribing Integrity The Prescription Project 30 Winter St. 10th Floor Boston, MA 02108 www.prescriptionproject.org (617) 275-2853 Peter T. Wyckoff, National Consultant Email: Pete.Wyckoff@yahoo.com