Health Care & Prescription Drugs News

As the Legislature finalizes their work on the Health Care Cost Control Bill, MASSPIRG supports the inclusion of seven provisions in the final bill, that are especially crucial to begin to contain the cost of health care.  Specifically, we urged the leaders of the House and Senate to include the following provisions in the final bill:

 

·        Pharmaceutical Gift Ban:  The gift ban included in the Senate bill (Section 26) is a crucial element of the bill’s cost-control efforts. Aggressive marketing tactics by drug companies – including the use of gifts, honoraria, and meals – lead doctors to prescribe expensive name brand drugs when equally-effective cheaper alternatives are available.[1]  These marketing tactics cost Massachusetts patients, businesses, and taxpayers millions of dollars a year:  One study estimated that Massachusetts would save nearly $400 million a year if doctors reached optimal prescribing behavior in six classes of drugs alone.[2] 

 

Furthermore, we support the inclusion of the gift ban because we doubt the effectiveness of industry codes of conduct.  Experience with these voluntary codes shows that they do not stop the giving of gifts:  After PhRMA enacted its 2002 Code on Interactions with HealthCare Professionals, pharmaceutical industry gifts and payments to physicians did not decline, but instead increased.[3]

 

·        Pharmaceutical Spending Disclosure:  The Senate bill (Section 26) further requires that pharmaceutical companies disclose the giving of any economic benefit not forbidden by the gift ban.  While we applaud the House bill (Section 12) for its requirements that pharmaceutical companies disclose their codes of conduct and investigation policies, we believe full disclosure of pharmaceutical gift spending is necessary to better understand the effects of this marketing tactic.  We urge you to support both provisions and require pharmaceutical companies to disclosure both their compliance with their code of conduct and the giving of economic benefits to prescribers.

 

·        Data-mining Ban:  The data-mining ban included in the House bill (Section 15) is needed to protect the integrity of the prescribing system.  Data-mining – a practice where pharmaceutical companies buy doctors’ prescribing records from pharmacies and use the information to target their marketing to high-prescribing physicians – interferes with the prescribing system to manipulate doctors’ prescribing behavior.  As a result, many patients are prescribed expensive medicines that are no better, and may be worse, than generic alternatives.[4] We urge you to adopt the House-passed data-mining ban.

 

·        Creation of a Special Commission:  We urge you to include the creation of a special commission, headed by the Inspector General, to provide study into the disposition  of the reserves of health insurers and hospitals, as provided for in the Senate bill (Section 33).  By exploring options available to the commonwealth, this commission promises savings through better regulation, oversight, and disposition of these endowments and surpluses. 

 

·        Creation of an Academic Detailing Program:  The academic detailing program included in both the Senate bill (Section 10) and the House bill (Section 5) is a needed counterweight to the industry’s commercial detailing and gift-giving marketing efforts.  Academic detailing programs are cost-effective ways to improve physician prescribing behavior and so reduce health care costs:  Based on other states’ experiences with academic detailing programs, Massachusetts can expect to save two to three dollars for every dollar we spend on academic detailing.[5]

 

·        Use of Uniform Claim Codes:  Currently, nearly one-third of all dollars spent on health care go toward administrative costs – and much of that is wasted on managing the tangle of bureaucratic claim codes created by different insurance plans.[6]  Conservative estimates project that the adoption of uniform claim codes will save Massachusetts hospitals over $50 million annually in administrative costs.[7]  We urge you to support the uniform claim code provisions included in both the Senate bill (Sections 19 and 23) and the House bill (Sections 16 and 24).

 

·        Public Reporting of Healthcare-Associated Infections and Serious Reportable Events:  We urge your support of facility-specific public reporting of healthcare-associated infections. The Senate bill (Section 34) requires reporting of infections but does not state that this reporting must be public; the House bill (Section 2) includes language about public reporting but does it in aggregate, rather than by facility. We urge you to support both provisions and require facility-specific public reporting of infections, as already required in twenty-two other states.  Additionally, we urge your support for facility-specific public reporting of, and nonpayment for, serious reportable events.  Massachusetts, as a health care insurer and payer, is already moving to prohibit payment for serious reportable events; we urge you to codify this so that it will apply across the commonwealth. 

 

Taken together, these seven provisions promise to begin to contain the cost of health care in the commonwealth.  I urge you to include these measures in the final bill to ensure Massachusetts citizens continue to have access to affordable health care, and to ensure Massachusetts remains a leading example for the nation as it contemplates health care reform.