Federal Academic Detailing Program Would Improve Health Care and Lower Costs

WASHINGTON - Today U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI), Senate Majority Whip Dick Durbin (D-IL), Senate Committee on Health, Education, Labor, and Pensions (HELP) Committee Chairman Ted Kennedy (D-MA), and Senator Bob Casey (D-PA) were joined by House Committee on Energy and Commerce Chairman Henry A. Waxman (D-CA), House Energy and Commerce Subcommittee on Health Chairman Frank Pallone (D-NJ), House Committee on Ways and Means Chairman Charles Rangel (D-NY), and House Ways and Means Subcommittee on Health Chairman Pete Stark (D-CA) in introducing a bill in both chambers to provide doctors with unbiased information on prescription drugs. This federal "academic detailing" program would provide physicians and other prescribers with an objective source of information on all prescription drugs, based on independent, scientific research.
A study in the New England Journal of Medicine projected that for every dollar spent on academic detailing, two dollars can be saved in drug costs. When doctors are better informed about the full range of drugs available on the market, they are more likely to prescribe the most effective treatment, as opposed to the latest brand-name blockbuster drug. The result is also lower health care costs, as generic drugs are more likely to be prescribed. Last year, the Journal of the American Medical Association (JAMA) published an editorial underscoring the need for physician access to unbiased research about the drugs available on the market.
"This bill will provide an important alternative to the way doctors currently get their information about drugs-from the drug companies themselves-a practice that seems to be fraught with conflicts of interest," said Kohl.  "By providing physicians with thorough, independent research on all the drugs available to them, we believe we can improve the quality of health care and reduce the cost of prescription drugs in America."
"Many doctors learn about new drugs from drug company salespersons who may not be objective," Durbin said.  "Studies confirm that when unbiased health professionals, armed with educational materials, provide guidance to doctors, they are more likely to purchase the best drug for the patient instead of the best deal for the pharmaceutical company." 
"This bill will provide for objective, scientific reviews of the available evidence on the safety and effectiveness of drugs, and will get this information to the physicians who need it, so they and their patients can make more informed decisions about what is best for their care," said Kennedy.
"This legislation is a cost-effective, common sense and practical solution to a serious problem - it is exactly the kind of support the federal government should be providing the states," said Casey. "I'm proud to note that Pennsylvania has one of the best and most innovative academic detailing programs in the country, with documented and measurable cost savings."
"For far too long, most of the information physicians receive to make prescribing decisions has come from the drug companies marketing reps, not independent experts," said Waxman.  "This important legislation will help provide doctors with the best objective information to help them make better clinical decisions in partnership with their patients."
"Quality health care includes the best use of all available medications," said Pallone. "Pharmaceutical companies have produced medicines that save lives and improve the quality of life but doctors need the best, objective information about prescriptions if they are to be used properly and effectively. This bill is good for health care in America, good for the medical profession and, most importantly, good for consumers and patients."
"Providing doctors and patients with direct access to objective, comprehensive information on prescription drugs can help save lives and money," said Stark. "This legislation will test ways to help doctors and patients make medication decisions based on facts, not manufacturer propaganda."
The Independent Drug Education and Outreach Act of 2009 would provide grants to produce educational materials for doctors on the safety, efficacy, and cost of prescription drugs, including generic and over-the-counter drugs. A second set of up to ten grants would be made available in order to dispatch trained medical staff (such as pharmacists, nurses, and other health care professionals) into physicians' offices to distribute and discuss the independent information. To ensure their neutrality, grant recipients may not receive financial support from any drug manufacturers whose products they are reviewing.  The recently-passed stimulus package designates $400 million dollars to the Department of Health and Human Services to accelerate the development and dissemination of comparative effectiveness research, which could be used to fund grants like those included in the Independent Drug Education and Outreach Act.
Currently, pharmaceutical sales representatives are one of the most common ways doctors learn about new drugs on the market, and evidence has shown that interaction with them can impact doctors' prescribing patterns. At an Aging Committee hearing on academic detailing in March 2008, a former sales representative for the pharmaceutical company Eli Lilly shared with the committee his experiences as a drug detailer and discussed the techniques sales representatives employ when marketing drugs to doctors. Other witnesses, including Dr. Jerry Avorn from Harvard's School of Medicine, outlined the concept of academic detailing, shared success stories from state and international programs already underway, and discussed both the documented cost savings of academic detailing programs and how patients stand to benefit when doctors have access to unbiased information.
The academic detailing legislation is part of a larger effort to change the way the pharmaceutical industry interacts with doctors. In January, Kohl and Finance Committee Ranking Member Charles Grassley (R-IA) reintroduced the Physician Payment Sunshine Act (S. 301) to require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. 
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·          Fund grants or contracts through the HHS Agency for Health Care Research and Quality (AHRQ) to develop educational materials.
Ø The grantee or contractor would develop educational materials showing the relative safety, effectiveness, and cost of prescription drugs, including generic and over the counter alternatives and non-drug treatments for selected conditions. These materials would include brochures, handouts, and electronic information accessible to both patients and doctors.
Ø Entities that can demonstrate clinical expertise in pharmaceutical research, such as medical and pharmacy schools and academic medical centers, would be eligible to apply.
Ø Applicants may not receive financial support from any manufacturer of the drugs being reviewed.
Ø AHRQ will review and approve the accuracy and effectiveness of the materials on a bi-yearly basis.
·          Fund ten grants or contracts through AHRQ to dispatch trained medical professionals into physicians' offices to discuss and disseminate the unbiased educational materials.
Ø Public entities and nonprofit groups are eligible to apply for the grant or contract, as are other entities that can demonstrate the capacity to train and deploy the medical professionals to disseminate and discuss the materials.
Ø Applicants may not receive financial support from any manufacturer of the products being discussed.
Ø The grant or contract recipients will hire and train appropriate staff, identify health care providers who will be the recipients of the outreach, and evaluate the effectiveness of the program on both cost and prescribing behavior. 
Ø Regulations will also be in place to ensure the accuracy and timeliness of the information being distributed, to prevent conflicts of interest, and to promote the effectiveness of the program.
"Patients are safer when doctors receive good, unbiased drug information," said Allan Coukell, director of the Pew Prescription Project. "Programs like this already exist in other countries and in several states, and they've been shown to improve care and generate savings."
The Prescription Project / Community Catalyst
HealthPartners Health Plan, MN
HealthPartners Medical Group, MN
Gray Panthers
American Medical Student Association (AMSA)
Consumers Union
Health Care for All (Massachusetts)
Medicare Rights Center
Mississippi Human Services Coalition
Minnesota Senior Federation
National Physicians Alliance
No Free Lunch
Tennessee Health Care Campaign
National Legislative Association on Prescription Drug Prices (NLARX)
American Association of Colleges of Pharmacy
UMass Memorial Medical Center
The Harvard Interfaculty Initiative on Medications and Society
The Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine,
Brigham and Women's Hospital / Harvard Medical School 
The Leapfrog Group
BlueCross BlueShield Association
The Marshfield Clinic
Prescription Policy Choices