AAOS Now

Published 11/1/2007
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Ryan M. Nunley, MD; the Washington Health Policy Fellows

Habit-forming: Access to physician prescribing patterns

Getting the data is easier than you think

An interview on National Public Radio this past summer revealed that the drug company representatives who visit physicians’ offices already know exactly what drugs an individual doctor prescribes. This knowledge enables sales representatives to hone their sales pitches and provide the doctors with journal articles and data on why their drug is better than the competition.

The data enables pharmaceutical sales representatives to see what drugs physicians prescribe—and how much they are prescribing. Before sales representatives enter an orthopaedic office, they already know which nonsteroidal anti-inflammatory medications the orthopaedic surgeon is prescribing (celecoxib vs. meloxicam vs. naproxen vs. ibuprofen). They can also see usage trends and determine whether a physician is increasing the use of one drug and decreasing the use of another.

Armed with this information, sales representatives can tailor their pitches and make their drug compare extremely well to those most often prescribed. They can also target those physicians within a group who are not using their drug and spend less time and energy with those who do use it.

How do they know?
Drug companies can get physicians’ prescribing data relatively easily. When a patient gets a prescription filled at a major pharmacy, a record of each prescription, minus the patient’s name, is sold to a data management company, which bundles information from multiple pharmacies. This bundled information is then sold to the pharmaceutical companies, who provide it to their sales representatives. Most physicians we polled were unaware that their prescribing data is entered into a nationwide database and sold to pharmaceutical companies.

Data management is a significant industry. IMS Health, for example, had an operating revenue of $1.96 billion in 2006; a substantial portion of this revenue came from sales to the pharmaceutical industry, according to the company’s annual report. Nearly half (47 percent) of sales to pharmaceutical companies was for “sales force effectiveness offerings,” which included “sales territory reports and prescription tracking reports.”

When doing research for this article, we were surprised to find that anyone with access to the Internet can go to one of several online Web sites and purchase specific physician prescribing information. In addition, most of these Web sites also sell other types of data about physicians and their practices, including state medical license numbers, Unique Provider Identification Number/National Provider Identification numbers, and physician Drug Enforcement Agency numbers (see Table 1).

Other data sources
Local pharmacies and online Web services aren’t the only ones selling physician information. Since the early 1990s, pharmaceutical companies have purchased information about physicians from the American Medical Association (AMA). As the nation’s largest physician organization, the AMA maintains the most inclusive physician Masterfile in the United States, with information on more than 820,000 living physicians. Although the AMA data files contain large amounts of data about individual physicians, they do not contain individual physician prescribing information. In 2005, the AMA received $44.5 million—about 15 percent of its total revenue—from the sales of database products.

In response to physician complaints, the AMA has established a program that allows physicians to limit dissemination of some of their prescribing information. The Physician Data Restriction Program (PDRP) can be found on the AMA Web site (www.ama-assn.org). The restriction can be removed at any time and is valid for only 3 years; the physician must then reenroll.

The restriction applies equally to all sales representatives, regardless of their company. Pharmaceutical manufacturers are required to check the program database at least quarterly, so it may take as long as 90 days before companies block the information provided to their sales representatives. The PDRP system also allows physicians to report concerns about the inappropriate use of prescribing data by a specific pharmaceutical representative or a specific company.

The PDRP program is separate from other restrictions—such as the “no contact” list, which prevents doctors from receiving solicitations through the mail—that physicians can place on how their Masterfile data are used. Although broad notification efforts have been implemented by the AMA, many physicians remain unaware that they can restrict access to their individual data maintained by the AMA.

What’s wrong with it?
Pharmaceutical companies firmly reject the idea that using physician prescribing data is inappropriate or increases the cost of health care. They argue that using physician prescribing data increases efficiency in conveying information, because sales representatives can provide physicians with the most current information about available medications, including the risks and benefits. If access to physician prescribing data were blocked, say the companies, physicians would see an increase in the number of sales calls, less targeted educational information, and fewer or less relevant drug samples.

Not all physician prescribing data are detrimental; if used properly, such data can benefit physicians by enabling them to self-evaluate by comparing their prescribing habits with evidence-based guidelines. Data can also be used to increase the efficiency of drug recalls and to monitor and assess benefits and risks after drugs have received marketing approval from the U.S. Food and Drug Administration. Prescribing information is also useful for public health agencies involved in studies about drug interactions, prescribing trends, long-term effects of medication, and preventing medical errors.

Recent legislation
In 2006, New Hampshire enacted legislation that superseded the AMA program and banned the outright use and sale, for most commercial purposes, of prescription data with identified prescribers. A federal judge, however, has since ruled that the law is an unconstitutional infringement on commercial free speech rights. The judge noted that little evidence was presented to show that pharmaceutical sales representatives use the information to harass physicians and said that physicians do not have a right to keep their prescribing data secret.

Despite this decision, Maine and Vermont have also recently enacted laws banning the use of physician prescription data. These laws are now being challenged in federal court by several large medical data collection firms, including IMS Health. Some organizations, such as Kaiser Permanente, do not make their prescription data available because they object to their use in influencing prescribing patterns; the limit, however, applies only to prescriptions filled in their pharmacies.

Other states may follow New Hampshire, Maine, and Vermont in enacting bans on using and selling prescribing data, but this controversy is likely to remain unsettled for several years. Physicians should be aware that pharmaceutical sales representatives (and patients) can obtain their prescribing records, and they should continue to use evidenced-based medicine when making decisions about which medications to prescribe.

The Washington Health Policy Fellows include Ryan M. Nunley, MD; Anil Ranawat, MD; James W. Genuario, MD; Alok D. Sharan, MD; Samir Mehta, MD; Aaron Covey, MD; John Flint, MD; Amir A. Jahangir, MD; and Sharat K. Kusuma, MD. References for this article can be found online at www.aaos.org/now

Did you know?

  • Drug company representatives visiting your offices already know exactly what drugs you prescribe.
  • Major pharmacies sell the record of each prescription, minus the patient’s name, to data management companies who distribute this information to pharmaceutical companies.
  • Pharmaceutical market intelligence is a global industry worth more than $640 billion, with an expected growth rate of 5 percent to 8 percent through the end of the decade.
  • Anybody with access to the Internet can purchase information about an individual physician’s prescribing record.
  • Approximately 15 percent of the total revenue received by the American Medical Association in 2005 was from the sale of physician database information.
  • Several states have passed legislation to block the sale of physician prescribing data, but the federal courts have determined these laws to be unconstitutional.