On­tario an­nounces ban on Big Pharma mar­ket­ing scheme

Use of soft­ware that favours brand name drugs over gener­ics ‘con­cern­ing,’ health min­is­ter says


On­tario is ban­ning a new Big Pharma mar­ket­ing scheme that uses elec­tronic med­i­cal records to sell drugs.

The pro­hi­bi­tion comes af­ter a Star in­ves­ti­ga­tion found Telus Health has been in­sert­ing elec­tronic vouch­ers for brand name drugs into its pop­u­lar med­i­cal record soft­ware (EMR) used by thou­sands of doc­tors across Canada.

“On­tario pa­tients must have con­fi­dence that (pre­scrib­ing) de­ci­sions are not in­flu­enced by mar­ket­ing pro­grams or elec­tronic vouch­ers,” Health Min­is­ter Eric Hoskins said in a state­ment.

“This prac­tice is par­tic­u­larly con­cern­ing given its pow­er­ful in­flu­ence on the brands of drugs that On­tar­i­ans re­ceive, of­ten with­out pa­tients even be­ing aware that this prac­tice is hap­pen­ing.”

The elec­tronic vouch­ers steer pa­tients to brand name drugs over their less ex­pen­sive generic equiv­a­lents, and have raised con­cerns that pa­tients’ health records are be­ing used to sell pricier drugs that can pile un­nec­es­sary costs onto pri­vate in­sur­ance plans.

The voucher fea­ture, found in med­i­cal record soft­ware owned by Telus Health and other com­pa­nies, will be dis­abled over the com­ing weeks, said Hoskins.

The min­is­ter said he is work­ing on the pro­hi­bi­tion in col­lab­o­ra­tion with On­tar­i­oMD, which over­sees and cer­ti­fies elec­tronic med­i­cal record soft­ware.

A Telus Health spokesper­son said the com­pany “has al­ways been care­ful to en­sure that our EMRs com­ply with pro­vin­cial pol­icy as it evolves over time.

“The min­is­ter’s di­rec­tive to the in­dus­try is clear, and we are tak­ing the nec­es­sary steps to im­ple­ment the re­quired changes.”

The Star had found that brand name drug com­pa­nies paid Telus to dig­i­tally insert the vouch­ers so that the pre­scrip­tion is filled with their prod­uct in­stead of the lower-cost generic com­peti­tor that phar­ma­cists nor­mally reach for.

The voucher works like a coupon: If a pa­tient’s in­sur­ance does not cover the full cost of the pricier brand name drug, the drug’s man­u­fac­turer will cover part or all of the cost dif­fer­ence from its generic equiv­a­lent.

Doc­tors had to agree to the voucher fea­ture in the Telus soft­ware be­fore it was en­abled on their sys­tems, and physi­cians could opt out at any time.

The Star found in some cases, doc­tors were un­aware they had in­ad­ver­tently en­abled the fea­ture.

Thou­sands of doc­tors across Canada use elec­tronic med­i­cal records to take notes dur­ing pa­tient vis­its and to cre­ate a pre­scrip­tion to be filled by the pa­tient’s pharmacy. Telus Health, a sub­sidiary of the tele­com gi­ant, is a dom­i­nant player in the elec­tronic med­i­cal records field.

Hamil­ton doc­tor Mon­ica De Benedetti ap­plauded the min­is­ter’s “strong and im­por­tant” de­ci­sion to pro­hibit elec­tronic vouch­ers.

“Pa­tient in­for­ma­tion should not be used for mar­ket­ing pur­poses — pa­tients aren’t ways to make money, they’re peo­ple we care for and try to keep healthy,” said De Benedetti, lead physi­cian for the Hamil­ton Fam­ily Health team, a net­work of165 physi­cians.

She said some of the team’s doc­tors were un­aware the vouch­ers had been added to their med­i­cal record sys­tem fol­low­ing a 2016 soft­ware up­date — nor were they aware that in­for­ma­tion about those vouch­ers was be­ing shared with drug com­pa­nies.

With­out the physi­cians be­ing fully aware, they could not tell their pa­tients about the pro­gram, De Benedetti said.

The health team en­cour­aged its mem­bers to turn off the voucher fea­ture, and De Benedetti and oth­ers raised their con­cerns with Telus and On­tar­i­oMD, a sub­sidiary of the On­tario Med­i­cal As­so­ci­a­tion that over­sees the cer­ti­fi­ca­tion of elec­tronic med­i­cal record soft­ware.

“I’m very glad to hear this is­sue has been pushed for­ward not just for our pa­tients but for all pa­tients in On­tario,” she said.

Telus said drug manufacturers pay­ing to have their vouch­ers in the EMR re­ceive “ag­gre­gated and anonymized, prov­ince-level statis­tics” on the to­tal num­ber of vouch­ers printed off for their prod­ucts, Telus said.

No pa­tient or physi­cian in­for­ma­tion is shared, the com­pany said.

Paul Lepage, pres­i­dent of Telus Health, pre­vi­ously said, “Pro­tect­ing our cus­tomers’ pri­vacy and safe­guard­ing data is, and will al­ways be, a cornerstone of our busi­ness.”

Telus Health said the voucher fea­ture has been pos­i­tively re­ceived by the ma­jor­ity of doc­tors us­ing the soft­ware. The voucher is of­fered only af­ter a physi­cian chooses a drug by its brand name to pre­scribe “so there is no in­flu­ence on what drug the physi­cian se­lects,” a com­pany spokesper­son said.

Mean­while, the brand com­pa­nies said the pay­ment as­sis­tance vouch- ers are about giv­ing the pa­tient choice be­tween brand and generic drugs with­out hav­ing to spend more money.

Crit­ics, how­ever, say vouch­ers ma­nip­u­late physi­cians’ pre­scrib­ing prac­tices, adding that many doc­tors use a drug’s brand name when writ­ing a pre­scrip­tion out of habit and aren’t nec­es­sar­ily in­struct­ing that a drug be dis­pensed over its generic.

The vouch­ers also re­in­force a false premise that gener­ics are in­fe­rior in qual­ity to the orig­i­nal brand name drugs, say doc­tors crit­i­cal of the fea­ture.

Gener­ics con­tain the same phar­ma­ceu­ti­cal in­gre­di­ents and can cost as lit­tle as one-fifth of the brand price.

To keep costs down, many drug plans en­cour­age phar­ma­cists to sub­sti­tute a cheaper generic drug when fill­ing a pre­scrip­tion for a brand drug, un­less the pre­scrib­ing doc­tor specif­i­cally re­quests oth­er­wise. With­out a voucher, even if a doc­tor uses the brand name on a pre­scrip­tion, phar­ma­cists may sub­sti­tute the cheaper generic.

The voucher fea­ture is of­fered in a num­ber of elec­tronic med­i­cal record sys­tems, a Telus spokesper­son said, adding that its soft­ware, which in­tro­duced vouch­ers in Au­gust 2016, fol­lows eth­i­cal prin­ci­ples not nec­es­sar­ily present in other soft­ware.

Telus has been a sig­nif­i­cant ben­e­fi­ciary of a pro­vin­cial gov­ern­ment­funded pro­gram that saw more than $340 mil­lion dis­trib­uted to doc­tors to adopt elec­tronic med­i­cal records in their prac­tices. Roughly half of the doc­tors who re­ceived fund­ing went with a Telus-owned EMR that now in­cludes the voucher fea­ture.

At St. Michael’s Hospi­tal in Toronto, about 100 physi­cians and nurse prac­ti­tion­ers in the fam­ily medicine unit use a Telus EMR to write pre­scrip­tions for their pa­tients. All have opted out of the voucher fea­ture.

A Star in­ves­ti­ga­tion found drug­mak­ers were in­sert­ing elec­tronic vouch­ers into pop­u­lar med­i­cal-record soft­ware.

Health Min­is­ter Eric Hoskins has di­rected drug vouch­ers be banned from elec­tronic med­i­cal records.

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