Drug reps and prescribing data: Doctors can choose to say no

"Doctor, why haven't you prescribed any of x drug?"

No physician should have to hear such a sentence from a pharmaceutical sales representative. That kind of grilling over prescribing decisions crosses a privacy line that shouldn't be breached. Yet armed with physician-specific prescribing data, some sales people are using this tactic and other pushy methods to pressure doctors to write scripts for their drugs.

Now physicians have a painless way to push back.

The American Medical Association last month announced creation of the Prescribing Data Restriction Program, which allows doctors to opt out of having their prescribing information shared with drug reps.

This step is a direct response to physician complaints about detailers' inappropriate behavior. The AMA House of Delegates in December 2004 and in June 2005 called on the Association to create a way for physicians to choose to shield their information.

Physicians who select this option will be flagged in the AMA's Masterfile, a database that contains such information as a physician's name, address and specialty. Health care information organizations buy this basic data, check it against similar materials they've already gathered from elsewhere and then combine it with prescribing information from pharmacies to develop a physician profile. They then sell these profiles to drugmakers, academia and the government.

All entities that purchase the data will now be contractually obliged to adhere to the opt-out program's restrictions on how the Masterfile can be used.

Pharmaceutical companies that break the rules by disclosing to their sales force data on doctors who have opted out risk losing access to the AMA information and the prescribing materials attached to it by the health information organizations.

The AMA has established a Web site physicians can use to opt out. They can register now, but doctors should allow several months for the decision to work its way through the process. The Association is also creating a mechanism for doctors to report complaints if drugmakers don't abide their choices to keep their information from drug reps. The AMA will take action on behalf of the physician based on the specifics of the situation.

Under the program, pharmaceutical companies will still be able to get prescribing data from the health information organizations. They use it for such tasks as compensating their sales forces and targeting sales and education campaigns. By allowing drug companies to maintain access to doctor-specific data, the program prevents irrelevant sales pitches.

It also preserves more altruistic uses of the information. These include efforts to promote health care quality and safety, to spread the word about drug recalls, and to prevent diversion. Without the incentive of profits from sales to drugmakers, health information organizations wouldn't collect the data on which these beneficial initiatives are based.

A handful of states have tried to take matters into their own hands. New Hampshire, for example, passed legislation that bars pharmaceutical companies from getting doctors' prescribing data. Gov. John Lynch is expected to sign the measure.

The bill's supporters argue that the practice drives up drug costs by promoting expensive name-brand medications. But they miss the point that allowing pharmaceutical companies to target their drugs to the doctors who might actually need to prescribe them saves money. They also ignore the harmful ramifications to all the positive programs that rely on this information.

The AMA's new program makes such state legislation unnecessary.

Meanwhile, the AMA is collaborating with the California Medical Assn. on a pilot project in which the health information organization IMS Health will give doctors detailed data they can use to compare their prescribing patterns with other physicians in their region and specialty.

It is important that physician-specific prescribing data be available for the many functions that benefit not just doctors but patients and the health care system as a whole. But physicians should have control of the decision to share this information with drug reps. The AMA's new program proactively addresses doctors' concerns while protecting the legitimate uses of this data.