Friday, August 05, 2005

Using Drug Supply Contracts to Censor Negative Drug Utilization Review and Counter-Detailing

The Wall Street Journal reported (see summary here) how at least one drug company places restrictions on negative communications to physicians about its product in contracts that give discounted pricing to insurers and hospitals. In particular, Eli Lilly & Co offers its new anti-depressant Cymbalta ( duloxetine HCl) at a discount but with provisions that bar "negative D.U.R. (drug utilization review) correspondence to physicians," and "negative educational counterdetailing." Thus the hospital or insurer would be contractually prohibited from communicating with doctors in ways that might discourage them from prescribing the drug.
According to the Journal, Tarra Ryker, a Lilly spokeswoman, "says the Cymbalta contract isn't meant to stop communications that are 'backed up by clinical data' and 'presented in a fair and balanced manner.'" Her justification was that "there are a lot of things that are said to physicians and prescribers that in a lot of cases cannot be backed up with scientific evidence."
She also noted that Lilly has similar contract provisions in contracts to sell Symbyax (a combination of fluoxetine and olanzapine) and Zyprexa (olanzapine). Lilly's practices apparently are not unusual. A Pfizer spokesman, Jack Cox, said, that counterdetailing "language is probably in everyone's contracts."
I have previously posted about secrecy in health care (here). It may be that drug utilization review and counterdetailing are sometimes biased. But figuring that out should be up to physicians. And drug companies have plenty of opportunities to get their own messages to physicians. Impeding the free flow of information to physicians about drugs and other aspects of health care does their patients no favor.

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