Vt. bans industry gifts, tightens reporting rules

Starting July 1, Vermont physicians will get no more free lunches from the pharmaceutical industry.

That is one of many changes doctors in the state can expect thanks to a new state law that may be the most sweeping attempt yet to target the influence of industry marketing on physicians' medical decisions.

The law, passed by wide margins in the Democratic-led Vermont House and Senate and signed into law in May by Republican Gov. Jim Douglas, covers gifts and payments from drugmakers, device makers and biotech firms.

In addition to the ban of most gifts, the law requires that industry publicly disclose payments to physicians, with reporting required for amounts staring at one cent. Reports are to be included on a Web site searchable by doctor name. Failure to disclose could cost companies $10,000 per violation.

The Vermont Medical Society backed the bill. The society's executive vice president, Paul Harrington, said the VMS supported the measure, despite the ban on all industry-provided meals, because it will ease concerns some patients might have.

The law "will make it clear that the vast majority of Vermont's physicians do not accept inappropriate payments from pharmaceutical companies, and their patients will be able to confirm that," Harrington said.

Vermont doctors and other health care professionals received more than $2.9 million in gifts and pay in fiscal 2008, an attorney general's April report stated. Fewer than 5% of recipients accounted for nearly $1.8 million, or 60% of the total payments. Food made up about 30%.

The attorney general's report was prepared using information disclosed in compliance with the state requirements set to be supplanted by the new law. The existing statute exempts gifts worth less than $25 from disclosure and, due to a trade secrets exemption, largely shields individual physicians from having their payments from industry revealed.

In April, a federal appeals court upheld a 2007 Vermont law that lets physicians choose whether to allow their prescribing data to be sold for use in pharmaceutical marketing. Doctors can keep their data away from drug reps and their direct supervisors by enrolling in the American Medical Association's Physician Data Restriction Program (link). About 22,000 doctors nationwide have signed up since the program was introduced in 2006.

Will other states follow?

Massachusetts has a total ban on industry-provided meals and gifts, but its law requires disclosure only of payments exceeding $50. Minnesota bans any gifts worth $50 or more and, along with Maine, the District of Columbia and West Virginia, requires disclosure of industry payments to doctors.

Similar bills have died or stalled in seven states this year, but measures are pending in two states. A gift-disclosure bill passed Texas' Senate Health and Human Services Committee and awaits a floor vote.

"As more and more states do something, then it kind of trickles down to other states," said Maine State Rep. Sharon Treat, executive director of the National Legislative Assn. on Prescription Drug Prices. She said taking a harder line on industry gifts and payments to physicians is now "viewed as a pretty mainstream idea."

The Pharmaceutical Research and Manufacturers of America opposed the Vermont bill.

The legislation was "totally unnecessary," said PhRMA Senior Assistant General Counsel Marjorie Powell. PhRMA's revised code in interactions with health professionals, effective in January, bars drug reps from handing out reminder items such as pens and note pads, and says meals must be accompanied by an educational offering. The device makers' trade group, the Advanced Medical Technology Assn., adopted similar rules in December 2008. The Vermont law "will do nothing to improve the access of patients in Vermont to physicians or prescription drugs or medical devices," Powell said.

PhRMA is reviewing the Physician Payments Sunshine Act, a bipartisan U.S. Senate bill that would require drugmakers to report any payments to doctors. Physicians who receive $100 or more a year from an industry firm would have those payments posted to a searchable Web site. AMA ethics policy says doctors should refuse gifts that do not benefit patients or that exceed $100 in value.

Though the Sunshine Act is still in committee, the Vermont Medical Society's Harrington said states may not wait for Congress. "I think Vermont may be in the lead," he said. "I anticipate many other states will follow along the same lines."