LETTER OF AGREEMENT FOR FINANCIAL SUPPORT
This form must be completed by the organization providing financial support for the CME activity and signed by the Joint
Provider Representative. The Joint Provider is responsible for submitting this to PAC/LAC.
PAC/LAC, as the accredited provider of continuing medical education, has the responsibility to assure that activities that are
certified for credit meet the criteria and standards of the Accreditation Council for Continuing Medical Education (ACCME).
Compliance with the standards for commercial support of continuing medical education (CME) is an integral part of the
process. One of the key factors related to the use of commercial support is the execution of a Letter of Agreement
between the accredited provider and the commercial interest (grantor) providing funding to support the activity. The
purpose of this agreement is to document the independence of the accredited provider and joint-Provider from any
influence of the commercial interest in the development and conduct of the educational activity and to establish the terms
and conditions under which the education grant will be received.
This Letter of Agreement between PAC/LAC (accredited provider) and _
contains the purposes, terms and conditions for which an educational grant in support of a CME activity is made.
Name of CME Activity:
Date of CME Activity:
Joint Provider:
Organization:
Representative:
Address:
Tel. No.:
E-mail:
The organization wishes to provide the following educational support for the above named activity: (please
check all that apply)
Unrestricted educational grant in the amount of:
$
Restricted grant to reimburse expenses for:
Faculty (list all):
All Expenses :
$
Support for Catering Function:
Travel:
$
Honorarium:
$
$
Other in-kind support (e.g. equipment loan, brochure distribution):
$
Please specify:
Advertisement or Exhibit:
$
Rev. 9/2014
LETTER OF AGREEMENT FOR FINANCIAL SUPPORT (cont’d)
TERMS AND CONDITIONS
1.
Statement of Purpose: Program is for scientific and educational purposes only and will not promote the commercial
interests products, directly or indirectly.
2. Control of Content & Selection of Presenters & Moderators: The commercial interest agrees not to attempt to direct
the content of the program.
3. Disclosure of Financial Relationships: Meaningful disclosures will be made to the audience, at the time of the program,
of commercial support and any significant financial relationship between the accredited provider, joint-provider and
the commercial interest or between individual speakers, moderators, planning committee, staff or authors and the
commercial interest related to the content of the CME activity.
4. Involvement in Content: There will be no “scripting”, emphasis, or direction of content by the commercial interest or
its agents. There will be no content review by the commercial interest.
5. Ancillary Promotional Activities: No promotional activities will be permitted in the same room as the CME activity. No
product advertisements will be permitted in the activity room or in the activity syllabus.
6. Objectivity & Balance: The accredited provider and the joint-provider will make every effort to assure that data
regarding the commercial interest’s products or competing products are objectively selected and presented with
favorable and unfavorable information and balanced discussion of prevailing information on the product(s) and/or
alternative treatments based on scientific evidence.
7. Limitations on Data: The accredited provider and joint-provider will assure, to the extent possible, meaningful
disclosure of limitations on data, e.g. ongoing research, interim analysis, preliminary data or unsupported opinion.
8. Discussion of “Off-Label” or Unapproved Uses: The accredited provider and joint-provider will require that presenters
disclose to the provider when a product is not approved in the United States for the use under discussion and such
information will be disclosed to the learner.
9. Opportunities for Debate: The accredited provider and joint-provider will assure meaningful opportunities for
questioning or scientific debate.
10. Independence of Accredited Provider and Joint-Provider in use of Contributed Funds:
a. Funds should be in the form of an educational grants made payable to PAC/LAC. PAC/LAC may delegate authority to
manage funds to the joint-provider with the condition that they will abide by the terms and conditions.
b. All other support associated with the CME activity (e.g. distributing brochures, in-kind donations, etc.) must be given
with the full knowledge and approval of PAC/LAC.
c. No other funds from the commercial interest will be paid to the program or course director, faculty, planning
committee members or others involved with the CME activity (i.e. additional honoraria, extra social events, etc.).
The commercial interest agrees to abide by all requirements of the ACCME Standards for Commercial Support of Continuing
Medical Education (appended) and all applicable laws.
The accredited provider and joint-Provider agree to abide by the ACCME Standards for Commercial Support for Continuing
Medical Education; acknowledge commercial support in activity brochures, syllabi, and other materials; and upon request,
furnish the commercial interest a report concerning the expenditure of funds provided.
__________________________________
___________________________________
Signature: Commercial Interest
Signature: Joint Provider Representative
Date
Date
__________________________________
Signature: Accredited Provider
Date
Rev. 9/2014