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.