Pharmaceutical Reps Question 08/01
A GFP member's institution is facing significant issues with pharmaceutical reps. They
would like to know if any other institutions have implemented or are considering
implementing restrictive policies regarding pharmaceutical reps.
Contact
School
Eugene Rich Creighton U
Steve
Verdolino
UConn
Reply
A colleague of mine and I have a paper coming out in American J of Managed
Care describing policies used by (non-Academic ) group practices regulating
PSR interactions and evidence suggesting such policies are associated with
lower Rx costs. A pre-published copy is available at the AAMC, but it cannot
be circulated.
At UConn, the medical school has restricted reps from contacting students,
interns and residents. The word is out and it is apparently being enforced
as many reps have made comments to me that they cannot meet with these
groups. This restriction is imposed at all 7 hospitals associated with the
residency program.
The hospital has restricted reps from any patient care area. Samples are
not allowed in the hospital but are permitted in the clinics. Other
discussions on whether to be more restrictive have taken place but no
action has been taken as yet. Our main obstacle to implementing more
restrictions is the open environment of the Health Center. If we cannot
enforce the restrictions, we won't impose them.
Janet
Peacock
Moye
Clifton
Louie
The Brody
School of
Medicine
ECU
UCSF Medical
Center
Yes, we have recently implemented a vendor policy and acceptance of vendor
courtesy policy to deal with the issue. I can share specifics if they would
like more info.
At UCSF, we have the usual policy: sign in, drop off literature, get a
badge, etc. We are planning to ban free lunches from drug representatives in
support of noon conferences.
Columbia Medical School has had a longstanding policy that prohibits reps from
our school environment, and sponsorship of educational events. We are trying
to convince our Hospital
(New York Presbyterian) to ban them from the clinical environment. This is
currently a topic of conversation at the combined Medical Board of the Hospital
for the Columbia Presbyterian and NY Weill Cornell campuses.
Kathleen
O’Donnell
Columbia
Patricia
Simmons
Mayo Clinic
We have restrictive policies, an organized body of the pharmaceutical reps,
and an oversight body. I'll ask my colleague if we could share that policy
with you.
Marianne
Hockema
Mayo Clinic
The Medical/Industry Relations Committee, for which I serve as
administrator, is the liaison with the Rochester Pharmaceutical
Representative Association. Before any member of the association can
"detail" within the clinic, they must join the association. In addition,
the association's bylaws must be approved by the Medical/industry Relations
Committee. I have attached a copy of the bylaws for your review. I think
you will find they are quite restrictive in many areas, especially in
defining how representatives may work on our campus.
The Med/Rel Committee also serves as the disciplinary liaison for Mayo with
respect to the pharmaceutical representatives. We receive all complaints
about representative behavior and we have a three-step disciplinary process
that begins with a verbal warning and concludes with a suspension of
detailing privileges.
One of the most helpful things we have initiated are quarterly meetings with
the officers of the Rochester Pharmaceutical Representatives Association.
We invite them to our campus and discuss issues both from their and our
perspectives. We also, in concert with our CME colleagues, provide
semi-annual education meetings for the RPRA membership.
To date, our relationship with this organization has been very positive and
effective.
If there is a need for any additional information or if you would like to view a
more detailed document, please feel free to give me a call.
John
Prescott
WVU School
of Medicine
Tom
Heckler
Oregon U
Pharmaceutical reps are required to check into the front desk at our
ambulatory clinic and hospital, to wear name tags, and have specific
itineraries during their visit. Unfortunately this is not always adhered to.
Reps gain access to docs and staff by bringing donuts, pens, and drug
information. Faculty are divided, some want to keep the reps out of patient
care areas and others feel it is important to expose staff and residents to
new drugs. I do not have formal policies to send.
Hospital Policy
Pharmaceutical sales representatives are prohibited from distributing
sample drugs to hospital nursing units.
The pharmacy will dispense sample drugs for inpatients only on the special
written request of the attending physician. Medical service Pharmaceutical
sales representatives may deliver to the clinics only those sample drugs
specifically requested by physicians. Unsolicited sample drugs are prohibited.
Nurses may not administer sample drugs to inpatients unless dispensed by
the pharmacy.
Clinics and Emergency Department
All drug samples will be stored in a secured area.
Only designated authorized personnel shall have access to the secured
area where sample drugs are stored.
Sample drugs may be dispensed to patients only by licensed physicians,
physician assistants, nurse practitioners, dentists, or pharmacists. Each
sample drug dispensed will have a label affixed which includes the patient's
name, route of administration, dose, frequency of dosing and duration of the
therapy. Sample drug dispensed will be documented in the patient's medical
record.
Sample drugs must be in manufacturers' ready-to-dispense packages.
Repackaging or dispensing of drugs from bulk containers by other than a
pharmacist is not permitted.
Controlled drug samples are not permitted.
Inspections will be conducted by the Nurse Coordinator or the Coordinator's
designee every two months. Outdated, deteriorated, misbranded, or otherwise
unusable sample drugs will be returned to the pharmacy for appropriate
disposal. The pharmacy shall be responsible for verifying that the inspections
have been done.
Pharmaceutical sales representatives may provide clinics only those
sample drugs specifically requested by practitioners or physicians. Unsolicited
sample drugs are prohibited.
PROCEDURE:
Ambulatory Practice
Responsibility:
Action:
Clinic Manager
1.All sample medications will be stored in a secured area. The
room in which they are stored will be locked after clinic hours. Cupboards in
which the medications are stored will have locking doors and will be locked
when not in use.
2.Only designated, authorized personnel shall have access to
the secured area where sample drugs are stored.
3.Inspections will be conducted by the manager or designee
every two months. Documentation of the inspection will be made on the
Medication Sample Inspection form (Appendix I), which will be posted on the
sample medication cupboard.
4.Outdated, recalled, deteriorated, mislabeled, or otherwise
unusable sample drugs will be
posted on the sample medication cupboard.
5.Medications which will expire in the coming month should
be returned to the Pharmacy for appropriate disposal.
6.Each sample medication dispensed will have a label affixed
that will list the patient's name, the route, amount, and frequency of dose and
length of administration.
7.All sample drugs dispensed must be entered on Sample
Medication Log (Appendix I).
8.Document sample medications dispensed in the patient's
medical record.
Sales Reps
Sales representatives will not visit any area of the Hospitals and Clinics on the
main OHSU campus (including, but not limited to the Physician's Pavilion,
Outpatient Clinic, Emma Jones Hall, Dillehunt Hall, Multnomah Pavilion, Casey
Eye Institute, Child Development and Rehabilitation Center, OHSU Hospital
South, Doernbecher Children's Hospital) unless registered with Public Safety
for each visit to OHSU.
Sales representatives are not allowed in any patient care area unless
accompanied by an OHSU employee. Sales representatives shall not disrupt
normal operations by interrupting employees in their work site with
product/drug detailing. Detailing of products/drugs should be done by
appointment only.
We do control access to ALL vendors including pharmaceutical reps. All must
register through the Purchasing Department, and must report there before
visiting on campus. They are not allowed in patient care areas--hospitals
and clinics--and must make appointments with those they wish to see.
Roy Clay
LSU
Shreveport
Joel Gore
U Mass
We are currently reviewing our own policy which is we don't have a policy.
I would be interested to hear what others have done.
Brian Smith
U South
Florida
Not a major problem for us yet.