TESTIMONY OF REP. SHARON TREAT
SPONSOR OF
LD 839, “AN ACT TO ESTABLISH A PRESCIPTION DRUG
ACADEMIC DETAILING PROGRAM”

April 30, 2007

Joint Standing Committee on Health & Human Services

Senator Brannigan, Representative Perry, and members of the Health & Human Services Committee. I am Sharon Treat, and I represent House District 79, Farmingdale, Hallowell and West Gardiner. I am testifying today in support of my legislation LD 839, “An Act to Establish A Prescription Drug Academic Detailing Program.”

What does the bill do? This bill would require DHHS to establish a prescription drug academic detailing program for the purposes of enhancing the health of residents of the State, improving the quality of decisions regarding drug prescribing, encouraging better communication between the department and health care practitioners participating in publicly funded health programs, and reducing health complications and unnecessary costs associated with inappropriate drug prescribing.

The program would be designed in consultation with prescribers and dispensers of drugs, carriers and health plans, hospitals, pharmacy benefit managers, consumers, the MaineCare Advisory Committee and the MaineCare drug utilization review committee. The program components would include:

• Outreach and education to prescribers and dispensers regarding the therapeutic and cost-effective use of prescription drugs based on scientific and medical research;
• Provided through written information and personal visits from program staff;
• Including information on clinical trials, pharmaceutical efficacy, adverse effects of drugs, evidence-based treatment options and drug marketing approaches that are intended to circumvent competition from generic and therapeutically equivalent drugs.

The program would be funded through existing fees charged to drug companies under the clinical trials education program already in statute, and would be eligible for funding from Attorney General settlements in cases involving pharmaceutical marketing and pricing. The program would be permitted to seek grants as well as charge subscriptions to private parties such as carriers, health plans, hospitals and employers interested in participating in the program.

What is academic detailing? Academic detailing is a way to provide better information to medical providers and consumers about which drugs are the most effective and have the least adverse effects, as well as information on the costs of these drugs. Rather than rely on pharmaceutical salespersons to provide this information, “academic” or “counter” detailing programs are independent from the drug companies and provide unbiased, balanced, evidence-based information to physicians and other medical providers. These programs use physicians, pharmacists, nurses and other clinical professionals to present scientific evidence to medical providers.

Why is it necessary? This Committee has already heard a great deal about detailing provided by the pharmaceutical industry. As you know, sales representatives provide information to medical providers about new drugs, clinical trials results and other research in sophisticated outreach programs. The pharmaceutical industry spends more than $12 billion to promote and market prescription drugs, with free samples and salespeople in physicians’ offices accounting for over three quarters of those costs . Academic detailing provides information that is not tied to a financial interest in increasing sales of particular products. Thus, it promotes evidence-based prescribing which should improve patient outcomes as well as reduce health care costs.

These cost savings and improved health outcomes have been documented in clinical studies. A formal benefit-cost analysis of a 4-state Medicaid academic detailing study involving 435 doctors showed savings of $2 for every $1 the program cost, based on just Medicaid paid claims data. The program also improved clinical outcomes. Reports of programs in other countries are similarly effective. A 6 month detailing effort involving 212 physicians in a single region of France from November 2005 to April 2006 yielded a nearly 30% reduction in annual antibiotics expenditures in that district, and savings greater than 500,000 euros.

Industry detailing drives up costs. As you have heard, industry detailing is extremely effective in increasing sales of the most expensive drugs, according to the industry as well as to independent researchers. I think it is worth reiterating the findings of Dr. Jerry Avorn and Dr. Aaron Kesselheim of Brigham and Women’s Hospital and Harvard Medical School and School of Public Health, who have studied the effects of industry detailing :

“Detailing is generally confined to high-margin, high-profit drugs, for which the manufacturer has a substantial incentive to increase sales. There is virtually no economic incentive for the manufacturers of generic drugs to send sales representatives to visit physicians about those products, even though there is clear evidence that these medications can provide therapeutically equivalent and much more affordable and cost-effective treatment in a wide variety of conditions. Thus, the work of pharmaceutical sales representatives drives drug use toward the most

Why is it necessary? This Committee has already heard a great deal about detailing provided by the pharmaceutical industry. As you know, sales representatives provide information to medical providers about new drugs, clinical trials results and other research in sophisticated outreach programs. The pharmaceutical industry spends more than $12 billion to promote and market prescription drugs, with free samples and salespeople in physicians’ offices accounting for over three quarters of those costs . Academic detailing provides information that is not tied to a financial interest in increasing sales of particular products. Thus, it promotes evidence-based prescribing which should improve patient outcomes as well as reduce health care costs.

These cost savings and improved health outcomes have been documented in clinical studies. A formal benefit-cost analysis of a 4-state Medicaid academic detailing study involving 435 doctors showed savings of $2 for every $1 the program cost, based on just Medicaid paid claims data. The program also improved clinical outcomes. Reports of programs in other countries are similarly effective. A 6 month detailing effort involving 212 physicians in a single region of France from November 2005 to April 2006 yielded a nearly 30% reduction in annual antibiotics expenditures in that district, and savings greater than 500,000 euros.

Industry detailing drives up costs. As you have heard, industry detailing is extremely effective in increasing sales of the most expensive drugs, according to the industry as well as to independent researchers. I think it is worth reiterating the findings of Dr. Jerry Avorn and Dr. Aaron Kesselheim of Brigham and Women’s Hospital and Harvard Medical School and School of Public Health, who have studied the effects of industry detailing :

“Detailing is generally confined to high-margin, high-profit drugs, for which the manufacturer has a substantial incentive to increase sales. There is virtually no economic incentive for the manufacturers of generic drugs to send sales representatives to visit physicians about those products, even though there is clear evidence that these medications can provide therapeutically equivalent and much more affordable and cost-effective treatment in a wide variety of conditions. Thus, the work of pharmaceutical sales representatives drives drug use toward the most

expensive products (as it is designed to do), and contributes to the strain on health care budgets for individuals as well as health care programs, especially Medicaid.”

According to Avorn and Kesselheim, the evidence demonstrates that “commercial sources play a disproportionate role” in shaping physician’s knowledge and prescribing decisions, and “[t]his influence is aimed primarily at increasing sales of the drugs being promoted, rather than at providing a balanced presentation of all the medical evidence.” In one study, 60% of physicians named commercial sources, such as detailers, as most influential in their first decision to prescribe a drug.”

Reliance on the industry for information also has public health implications. One study of detailers’ promotional brochures found that 15% of the pamphlets presented data that differed from the published studies on which they were based. In another study, 11% of the statements made by pharmaceutical representatives about drugs were scientifically inaccurate, and physicians generally failed to recognize the inaccurate statements. Detailers are also key promoters of off-label use of drugs, a consistent finding of the Prescrire sales reps monitoring network in France. For 15 years, members of the Network compared sales representatives’ claims with the information contained in the summaries of product characteristics. Results were remarkably consistent over the years - sales representatives highlighted the efficacy of the drugs, often for unapproved as well as approved indications. In contrast, adverse effects were not mentioned in three-quarters of visits.

Programs in other states. A number of states have already initiated programs to provide more balanced information to prescribers through counter detailing. The most extensive of these programs in the United States is the Pennsylvania Independent Drug Information Service (www.rxfacts.org). The program makes use of sophisticated “marketing” materials (“unadvertisements”), clinical information, drug information consultants, and patient education materials to help facilitate prescribing change. The academic detailers have clinical background (nursing, pharmacy). Michelle Spetman, who manages this program, will be testifying later in this hearing and can provide details about how the program works, its costs, and anticipated savings.