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Drug Information and Communication
in the Obama Era
John KampExecutive Director
Coalition for Healthcare CommunicationAMM, January 21, 2010
What Next ?
• MA election changes the dynamic, especially for Blue Dogs, Moderate D’s
• Two clear possibilities– House Passes Senate version, sends to WH– Scaled down version, but what to save, what to
discard
• Expect WH, Senate Leader, Speaker summit meeting very soon; President cannot deliver State of the Union without a plan
So, what about big FourCommunication Issues ?
• Tax on Medical Marketing– Maybe back on the table
• Transparency– Maybe stays, one of the few items with bi-
partisan support– States active anyway
• Marketing use of prescription data
• Expanded Brief Summary
A few Kamp Rules of Washington
• Never wake a snake to kill it– Watch, listen very carefully
• Dig the well before the drought– Keep you pens and email lists very handy
• No good or bad idea dies, it just waits for another day
• Keep your friends very close, enemies even closer..
It’s not (just) Medical Communication
• Public Perception of Pharma/Biotech/Device Industries– Approval ratings near lawyers, car dealers &
former President Bush; just above insurers
• Fears about safety; Congress, FDA, consumers, prescribers, press
• Cost of Drugs
• Politics of Health Care Reform
Challenges Abound• Industry funding of organized medicine challenged
by Congress, ACCME, Macy, IOM, Med Pac• “Transparency” bills in states & Congress require
additional disclosures of all relationships with prescribers
• Whistleblower & HHS-IG/State lawsuits, CIAs & DPAs• Detailing, sampling & promotional education limited
by medical schools, managed care, some practice groups
• State limits on commercial use of prescriber data in New Hampshire, Vermont & Maine
• “Counter-detailing” in PA, VT, DC• Plaintiff Class Action Suits
Hill Priorities Beyond HCR:Past is Prologue
Unfinished business from 2007-8– National Registry of gifts and payments;
Grassley/Kohl/DeFazio/Stark– Limits consumer ads; Kennedy/Waxman/Stupak– Safety “reviews” of ALL new drugs & marketing
plans; Kennedy, Dingell, Waxman– Tax penalty for all marketing; Rahm Emanuel
Likely FDA Agenda• FDAAA of 2007 still sets priorities for 2008-10
– Dozen rules and reports mandated– Critical Path--modernizing the clinical trial– Advisory Committee recruiting/conflict issues– REMS – New databases for AERs, safety, etc.– Customs, foreign inspections for food & drugs– Bio-similar pathway– Integrating new personnel– Plus new Tobacco jurisdiction, Center in FDA
• Congress may:– create a new Federal Food Safety Admin
FDA Communications Agenda
• Enforcement
• DTC Reviews & Penalties
• Risk “draft guidance”
• Communication Advisory Committee
• Off-label enforcement
• REMS Program review
• Internet/Social Media Hearings
Broad Safety Provisions FDA Amendments Act of 2007
• Active surveillance system– Public/private partnerships
• REMS– Communication programs– Restricted use
• Labeling powers• New power to require studies, reports, and
clinical trials
Tax deduction for marketing biopharmaceuticals and devices
• $37 B in tax revenue requires $100 B in expenditures over 10 years– Companies in approx. 37% tax bracket
• $10 Billion per year no longer deductible– Not just DTC – DTC “rack rate spend” = $4.2 B; probably under $3 B– Requires $7 Billion in other expenditures, i.e., must
include all agency type communications & some other marketing costs
Transparency popular & important
• Intended to dampen company-prescriber interaction• Revenue neutral• Target for Class Action lawyers• House version
– Strict liability reporting by companies– “Death Penalty” for Non Compliance– targets association payments, grants, threatens medical
society memberships
New Labeling Requirements
• Jack Reed, Rhode Island
• S-1142: Informed Health Care Decision Making Act
• Would empower FDA to develop new “brief summary” labeling and advertising requirements– Drug benefits and risks box– Comparative effectiveness
Reed Amendment (cont.)
• One year study, then FDA empowered to enact rules
• Legislates “brief summary”– Holy Roman Empire analogy fades
• Further support for FDA Risk Guidance
• Could undermine First Amendment challenges to FDA ad regulations
Prescriber Data Provision
• House Education and Labor Committee includes HR 3200, Section 138
• Federal Version of New Hampshire statute
• Reduced to a study by HHS, but will not go away
• HIO Alliance includes IMS, WK & SDI-Verispan
Meanwhile, States Very Active
• Minnesota first to require registries of payments, gifts to prescribers, now source for NY Times
• New Hampshire, Maine, Vermont, DC & Mass. pass new legislation
• Congress supports state whistleblower statutes• NLARx & Prescription Project have proposals in
nearly ½ the states, energized by Vermont court decision
Federal & State Prosecutions
• False Claims act– Focus on “off-label” information that leads to
prescribing, thus “false” reimbursement by Medicare, Medicaid, etc.
– New interpretation of FDA labeling rules
• Anti-kickback Act– Punishes bribes and gifts to physicians
• Over $4.5 Billion in Settlements since 2000
Public & Private Law Suits
• New private actions, negligence torts in wake of safety publicity
• High profile actions against Wyeth (phen-phen), Merck (Vioxx) -- GSK (Avandia)
• But, class actions may be limited, e.g., Merck• But, new theories every day, e.g., failure to
inform
Kamp Crystal Ball
• Clouded at best, maybe shattered• Some hope
– Excellent leadership choices by Obama– Health reform part of economic crisis
• Some despair– Financial times limit alternatives– Unrealistic expectations re: free healthcare, drugs
• Some certainty– Healthcare top priority of Boomers– Critics of healthcare communications energized– Change, change, change
Communication Policy Issues
• Value of Medical Communications Not Clear to Policy Makers– Patient care connection not explicit– Concerns about cost of marketing– Policy value of marketing outcomes not well measured,
distributed – Doctors and patients must join effort
• Communication professionals must respect economic & political realities & be prepared to adapt to rapid change
• Must BE and be SEEN as part of the solution
For More Information
• John Kamp
• Coalition for Healthcare Communication
• www:cohealthcom.org– 212-850-0708– 202-719-7216– [email protected]