In late August, Boston residents were rocked by a report that insurers were paying local doctors $100 every time they switched a patient from Lipitor to a generic cholesterol-lowering drug–usually without patients knowing why the switch was being made–in an effort to contain health care costs.
A few weeks later, U.S. Sens. Chuck Grassley (R-IA) and Herb Kohl (D-WI) introduced a bill that would require pharmaceutical companies to disclose all the gifts and payments they give doctors that might affect their prescribing habits.
Both events focused national attention on a growing concern that someone other than one’s own doctor might be calling the shots in individuals’ health care–and sometimes, putting them in danger.
The Lipitor story raised eyebrows in light of a study, to be published later this year in the British Journal of Cardiology, showing patients switched from Lipitor (manufactured by Pfizer) to a generic cholesterol-lowering drug were 30 percent more likely to suffer a heart attack. The study was sponsored by Pfizer. According to WCVB TV in Boston, Michigan’s Blue Care Network paid 2,400 doctors $2 million to switch patients to the generic between January and March 2007.
“The standard is, once a physician gets a patient well-established on a therapy that’s working, then you need some kind of compelling reason to change that therapy,” said Dr. Merrill Matthews, director of the Council for Affordable Health Insurance and a former member of a hospital ethics review board.
“If patients have to pay for the drug out of their own pockets and ask to try something less expensive, that’s an ethical reason,” Matthews continued. “If there’s an HMO saying they’d be willing to give doctors $100 for doing it, that’s an unethical reason.”
Dr. Richard Dolinar, an endocrinologist in Arizona and senior fellow with The Heartland Institute, agreed–but he noted pharmacy benefit managers can be even more insidious than insurers who pay doctors to change prescriptions.
“If you offer a doctor money up-front, he can choose whether he’ll do it or not, to take the money or just treat the patient the way he wants,” Dolinar explained. “The other side is, ‘Dr. Dolinar, we’re not going to let you use that drug, or we’ll make you jump through all these hoops. You have no choice.’ They twist your arm. Anybody with a formulary can do that. Nobody sees that except the doctors.”
Rob Restuccia, executive director of The Prescription Project–a consumer-advocacy group launched in February by Community Catalyst and the Institute of Medicine, funded by the Pew Charitable Trust–agreed.
“Any incentive needs to be in the interest of the patient and not just the payer,” Restuccia said. “It gets a little bizarre out there–you start feeling like the patient is taking a back seat to everything else.”
The Grassley-Kohl Senate bill (the Physician Payments Sunshine Act of 2007) would require large manufacturers of any drugs, devices, or medical supplies paid for under government programs to reveal what they pay doctors–including funding for conferences, travel, or speaking. Minnesota and Vermont have similar laws in place.
“Gifts do have a profound influence on physicians, and this is well documented in the literature,” Restuccia said. “Oftentimes it’s very subtle, in that physicians don’t even know they’re being influenced.”
Karla Dial ([email protected]) is managing editor of Health Care News.