Pharmaguy's Insights Into Drug Industry News
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Pharmaguy's Insights Into Drug Industry News
Pharmaguy curates and provides insights into selected drug industry news and issues.
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“Blue-Green Coat Marketing”: How Some Drug Companies Use Nurses to Illegally Promote Drugs to Docs

“Blue-Green Coat Marketing”: How Some Drug Companies Use Nurses to Illegally Promote Drugs to Docs | Pharmaguy's Insights Into Drug Industry News |

Three more drug makers allegedly relied on schemes in which nurses were used to illegally promote its diabetes medicines to physicians, according to recently unsealed lawsuits. The documents describe how Gilead Sciences (GILD), Amgen (AMGN), and Bayer Pharmaceuticals (BAYRY) hired nurses to talk up treatments to doctors and their patients, an arrangement that purportedly violated federal kickback laws.


The companies avoided concerns that sales reps might get little to no face time with doctors and simultaneously helped save physicians from the expense of providing follow-up care, according to the lawsuit. The approach is sometimes known as “white coat marketing,” which the lawsuit noted is considered problematic by authorities because it may blur trust between doctors and patients. [But nurses do not wear white coats – they wear blue or green coats]


In each lawsuit, the drug makers allegedly used various means to improperly use nurses to promote their medicines. One way supposedly involved using a third party to deploy nurse educators to tout drugs [see my insights]. The companies also provided free nurses and reimbursement support services to save physicians money and to induce them to prescribe their medicines, according to the lawsuits (here is one and here is the other).


As a result, the schemes allegedly caused Medicare and Medicaid to inappropriately pay for prescriptions that were “tainted by kickbacks,” according to the lawsuits. The lawsuits also named other companies that were engaged to further their goals, including Covance, HealthStar Communications, and AmerisourceBergen. We asked each of them for comment and will update you accordingly. An Amgen spokeswoman declined to comment.


A Bayer spokesman, meanwhile, writes us that the company “believes that this case has no merit and categorically denies each of the allegations in the complaint. It is important to note that the U.S. Department of Justice and 31 states were provided an opportunity to participate in this matter and upon review of the allegations specifically declined to intervene. Bayer looks forward to defending this matter and these medications.”


The allegations are nearly identical to claims that were contained in yet another lawsuit that was filed against Eli Lilly (LLY). All three of the lawsuits, which were filed last June in a federal court in Texas and unsealed more recently, were initiated by Health Choice Advocates, a unit of a health care research that describes itself as a whistleblower.

Pharma Guy's insight:

In 2006 I wrote about attending a conference where Innovex -- a division of Quintiles, the contract research people -- talked about the role of "Clinical Educators" (CEs) as adjuncts to pharmaceutical sales reps. CEs are essentially specially trained nurses that either work directly with physicians, their staffs, or with patients to do disease management, educate patients and enhance patient compliance with treatment -- all things that physicians should be doing themselves but are either too lazy to do or just not willing to do.


The use of nurses by Big Pharma in the US may be a new phenom and has attracted media attention. Another potential problem is the conflict between non-promotional and promotional aspects of CE programs. Innovex admits that CEs are "dedicated" to the sponsor's product (Business Week says "Admittedly, the nurses talk up their employers' products, both to the patients and to medical personnel in doctors' offices."). Where is the line drawn?

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Pharma Industry Capitalizes on “Most Trusted” Status of Nurses to Influence Prescribing

Pharma Industry Capitalizes on “Most Trusted” Status of Nurses to Influence Prescribing | Pharmaguy's Insights Into Drug Industry News |

A study by the University of Sydney found Australian nurses attended thousands of industry-sponsored events over four years.


Researchers analysed reports from trade association Medicines Australia on sponsored events for health professionals and found nurses attended more than 46,000 in the four years up to September 2015.


The study, which was published as a research letter in the journal JAMA Internal Medicine, suggested much more attention had been given to payments from pharmaceutical and medical device companies to doctors to date.


“Although a small proportion of nurse attendees had prescribing authority, non-prescribing nurses may have been routinely included in pharmaceutical industry-sponsored events, which perhaps reflects their role in medication compliance, the management of chronic disease, and hospital purchasing,” said the letter.


Commenting on the study, Elissa Ladd, associate professor in nursing, and Alex Hoyt, assistant professor in nursing, both from the MGH Institute of Health Professions in Boston, said the findings had “important global lessons”.


“The frequent presence of nurses at pharmaceutical company-sponsored educational events indicates they are valued by industry in a way that has heretofore gone unnoticed,” they wrote in a linked commentary in the journal.


The two US nurse academics suggested that pharmaceutical companies would not continue to invest in nurses in this way unless there was a good return.


“Financial allocation for promotion to nurses most certainly provides a very positive return on investment for the pharmaceutical industry; they would not continue to invest in these activities unless they resulted in favourable financial outcomes,” they said.


The industry may see nurses as “very influential” in purchasing or when it came to more informal guidance for patients on treating for chronic conditions.


“In addition, nurses without prescribing authority may influence prescribing patterns by steering prescriptions toward the brand-name drug brought by pharmaceutical representatives or suggesting that patients start with samples,” they wrote.


Drug companies may well be seeking to capitalise on the fact nursing was the “most trusted” profession, as suggested in a recent Gallup poll, they added.

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