How Pharmaceutical Companies Limit Information

While the editorial pages of the Wall Street Journal consistenly takes the corporate Republican line, the news pages often do show what is really going on in the world. Today they provide insight into how pharmaceutical companies influence prescribing of their medications. The article looks at Eli Lily and Cymbalta, but this applies to other pharmaceutical companies as well.

From TV commercials to pitches in doctors’ offices, drug companies try to cast their products in the best possible light. Some use a far less visible approach: contractual restrictions on what insurers, hospitals and other health facilities can tell doctors about certain drugs.

Drug makers commonly offer price breaks to insurers, hospitals and other medical facilities. In exchange, they often get favorable placement on drug formularies, the lists these entities use to encourage prescriptions of certain products. Some of the contracts go further, restricting insurers and medical organizations from making unflattering statements about the costs and risks of drugs when they communicate with health practitioners.

A case in point is the discount contract Eli Lilly & Co. has offered health facilities in connection with Cymbalta, an antidepressant that the Food and Drug Administration approved last year and that faces competition in some cases from cheaper generics. The contract illustrates tactics that some insurers and prescribers say they find troubling.

The Cymbalta discount contract offers large purchasers of antidepressants a 5% discount, but specifies that they could lose most of that discount if they engage in, among other things, “negative D.U.R. correspondence to physicians.”

While not defined in the contract, D.U.R. is industry shorthand for “drug utilization review,” a kind of analysis of prescription patterns that insurers often use to identify inappropriate or risky practices and often also to cut costs. Prime Therapeutics LLC, an Eagan, Minn., pharmacy-benefits manager owned by nine Blue Cross Blue Shield plans, used drug utilization reviews to try to reduce what it determined was overprescribing of Vioxx and Bextra, painkillers that were later pulled from the market because of safety concerns.

The article later discusses further restrictions on communication:

Also restricted under the Cymbalta contract is “negative educational counterdetailing.” Counterdetailing is the industry name for efforts, often made by insurers, to counterbalance drug makers’ sales pitches (which are often referred to as “detailing”). Counterdetailing efforts commonly push patients toward generics or poke holes in drug makers’ claims about their products.

People in the drug industry say counterdetailing often serves to steer patients toward cheaper drugs. Counterdetailing “language is probably in everyone’s contracts,” says Jack Cox, a spokesman for Pfizer Inc., New York. He declines to comment on Eli Lilly’s or Pfizer’s practices specifically, but adds that insurers and others who make drugs available to patients “will come in with clinical data, but their goal is financial.”

Information from insurance companies sometimes also appears biased towards their goals of reducing costs. It would be best if all parties remained free to provide their best arguments, preferably supported by scientific data, and to allow physicians to decide upon the prescription with all information available.