More States Explore Laws on Gifts to Physicians

A Vermont law enacted last year that bans pharmaceutical-company gifts to physicians may have provided the template for similar legislative efforts in other states.

Among the most recent efforts to limit gifts from pharmaceutical companies to clinicians is a proposal by New York Gov. David Paterson (D) to restrict gifts and prohibit drug-company representatives from giving misleading drug-research data when promoting use of specific drugs. The proposal—included in Paterson's annual budget plan released in January—also would ban payments to physicians outside of formal contractual consulting arrangements between them and drug companies.

The measure contains serious teeth, including physician fines of up to $10,000 for failing to disclose a financial conflict during a medical-conference presentation, for example.

If the New York initiative is enacted, the state will join Vermont and eight others that have enacted legislation affecting some aspect of drug marketing, according to the National Conference of State Legislatures.

Another state that may take action on the issue is Minnesota, where the legislature is considering various approaches to restrict pharmaceutical-company interactions with physicians. One bill (HF 1641) would expand the state's 17-year-old ban on gifts worth more than $50 to include gifts to physicians of any value and require disclosure of any payments to them. Another bill (HF 1640) would require the companies to fund state-employed pharmaceutical experts to provide clinicians with the latest evidence-based prescribing information.

The New York and Minnesota initiatives are opposed by the Pharmaceutical Research and Manufacturers of America (PhRMA) based on the belief that they would add barriers to drug companies' efforts to share helpful medication information with physicians. Drug-industry research indicates that prescribing and drug spending increases over the last decade in Minnesota have largely followed national trends, despite the existing 1993 ban on gifts over $50, according to PhRMA.

Pharmaceutical representatives also note that the industry already has a voluntary code of conduct and that the Food and Drug Administration regulates its marketing practices.

Meanwhile, the AMA says that physicians should not accept gifts worth more than $100 that do not benefit patients. In a related effort, the APA Board of Trustees voted in March 2009 to phase out industry-supported symposia and meals provided by pharmaceutical companies during APA annual meetings.

“There is a perception that accepting meals provided by pharmaceutical companies may have a subtle influence on doctors' prescribing habits,” said James H. Scully Jr., M.D., APA's medical director, in a written statement.

Similarly, Paterson described the New York initiative as an effort to prevent pharmaceutical companies from influencing the prescribing habits of physicians.

Critics have increasingly focused on gifts and payments to physicians as a primary cost driver of rising prescription-drug spending. Any gifts, including ones of nominal value, create an “unconscious and unintentional” bias that leaves clinicians more likely to prescribe expensive brand-name drugs over generic alternatives, according to a July 2003 behavioral analysis published in the Journal of the American Medical Association.

Legislators in at least five other states proposed physician gift bans or disclosure bills last year: Mississippi, New Mexico, Colorado, Illinois, and Maryland. Some of the bills were voted down, and a couple were continued into this year.

Mandated reporting of physician gifts and payments from pharmaceutical and medical-device manufacturers also was included in both House and Senate versions of health care reform (HR 3962 and HR 3590). That legislation would not limit such gifts or payments but would require the companies to report them for publication on a single public Web site.

The Minnesota legislation can be accessed at <www.leg.state.mn.us/leg/legis.asp> by entering the bill numbers, 1640 and 1641. Information on the New York governor's physician-payment initiative is included in his budget proposal posted at <http://publications.budget.state.ny.us/eBudget1011/fy1011littlebook/BriefingBook.pdf>.