Monday, February 16, 2015

John Oliver, Open Payments and the see-through pharma sales paradigm

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By Matthew Arnold, Principal Analyst, Manhattan Research

For most of its seven-year-long gestation process, the Physician Payments Sunshine Act struck pharma policy hands as an unnerving, if somewhat distant and abstract, threat – a dark cloud on the horizon which they hoped would blow away, but knew probably wouldn’t. The legislation’s bipartisan proponents, including the famously bullheaded and irascible Sen. Grassley, pressed on with stubborn patience. Muckrakers like ProPublica’s Charles Ornstein methodically pieced together the case for transparency. And finally, the legislation was absorbed into the Affordable Care Act, an epochal everything-and-the-kitchen-sink omnibus bill that just squeaked through Congress in March, 2010 and went on to survive a Supreme Court challenge and a presidential election.

Implementation took a while, as CMS had bigger fish to fry, but now, at last, the Open Payments database envisioned in the law is online (if, perhaps, a bit buggy yet), and anybody can look up how much their doctor has taken from pharma in lunches, speaker fees and the like. The Daily Show alum John Oliver crashed the site the other day, when he sent his viewers there after delivering a typically tart monologue about the evils of pharma marketing.

Oliver’s skewering of pharma payments to doctors was hilarious, but it was also a little bit dated.

“Drug companies know that doctors hold all the real power in the prescription drug business,” said Oliver. And that was true ten years ago, but nowadays, the real power resides in the pharmacy and therapeutics committees that draw up formulary lists that doctors must follow.

“Drug companies are a bit like high school boyfriends,” he continued, citing a BBC claim that nine out of ten top pharmas spent more on marketing than on R&D. “They’re much more concerned with getting inside you than with being effective once they’re in there.” And that might have been true for some brands not so long ago, too, but in an age of data mining for post-market safety signals, comparative effectiveness studies and clinical trials transparency, me-too duds increasingly have nowhere to hide.

When the ACA’s payments to physicians reporting requirement went into effect 18 months ago, The Wall Street Journal reported that doctors said “the increased disclosures are making them rethink their relationships with industry, citing concerns about privacy and accuracy, and worry that the public will misinterpret the information. Some fear patients will view the payments as tainting their medical decisions, and will lump together compensation for research-related services with payments of a more promotional nature.” Our most recent ePharma Physician study showed high awareness of the law – nearly one-third of ePharma Physicians said they were familiar with the content of the Sunshine Act, and another two in five (38%) said they had heard of it but didn’t know the details. Yet nearly two-thirds of respondents familiar with the law said it would not impact their use of pharma reps, online promotional programs and other resources from pharma.

Physicians are ever more likely to be employees of hospitals and health systems, and their employers are ever more likely to participate in Accountable Care Organizations, Patient-Centered Medical Homes or other programs which pay them based on patient outcomes, engagement and satisfaction. They’re no longer calling the tune – or writing the script based solely on their own clinical judgment. Pharmas that have been flipping the sales script, as GSK has, aren’t solely correcting for past excesses or engaging in a cynical PR exercise – they’re responding to market realities that render the old marketing model irrelevant.

In a sense, Open Payments, having been built to map the incentives of another time, is also irrelevant. It will continue to generate headlines, provide late night comedians fodder for laughs and raise legitimate questions about why physicians prescribe particular medicines, but its casus belli belongs to the Blockbuster Era.

About the author: Matthew Arnold is Principal Analyst at Manhattan Research, a Decision Resources Group company that uses proprietary data and analytics to help healthcare and life sciences companies understand healthcare consumer and professional use of digital technology. For a taste of what they do, see their presentation of Digital Trends Pharma Should Use Everyday at ePharma on Tuesday, February 24. For more of Matt’s musings on digital healthcare, check out the Manhattan Research blog.

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