Pharmacy data-mining: Physicians, independent pharmacists sound off

July 15, 2011

As expected, the U.S. Supreme Court recently struck down a landmark case that would have prohibited data-mining companies from selling physicians' prescribing information to pharmaceutical manufacturers for use in marketing. Still some independent pharmacists say they are not in favor of the practice.

Key Points

As expected, the U.S. Supreme Court recently struck down a landmark case that would have prohibited data-mining companies from selling physicians' prescribing information to pharmaceutical manufacturers for use in marketing. Still, some independent pharmacists say they are not in favor of the practice. In the landmark commercial free-speech case William H. Sorrell, Attorney General of Vermont, et al., v. IMS Health Inc., et al., the court considered the constitutionality of a Vermont law banning the use of physicians' prescribing history in the marketing of drugs.

This is how the practice works. Retail pharmacies sell information about the prescriptions they fill to data-mining companies such as IMS Health. Then, according to a recent editorial in the New England Journal of Medicine, the prescribing information of individual doctors can be associated with the Physician Masterfile of the American Medical Association (AMA), linking physicians with the types of drugs they prescribe. The information is then sold to pharmaceutical manufacturers, who use the data to market specific drugs to the offices of certain doctors.

Even though patients' names are not transferred in this data-mining process, the authors of the editorial do not believe the practice should be allowed. Pharmacists who spoke with Drug Topics agreed.

"We are concerned that such selling of prescribing data to pharmaceutical companies results in the manipulation of physicians' drug-prescribing practices, unwarranted intrusion into the privacy of the doctor-patient relationship, and an increase in costs at a time when our health care system is under unprecedented financial strain," wrote Gregory Curfman, MD, and other physicians in the May 26, 2011, issue of NEJM. Curfman is assistant professor of medicine at Massachusetts General Hospital.

Data mining can increase healthcare costs because drugmakers use the information to increase sales of costly branded drugs over affordable generic alternatives, said the editorial. In addition, retail pharmacies, data-mining companies, drug manufacturers, and the AMA profit from buying and selling patient information.

"In the end, the costs are passed along to patients, and physicians' prescribing practices are manipulated by drug salespeople who know the details of their interactions with their patients," wrote Curfman, et al.

HIPAA and undue influence

Independent pharmacists contacted by Drug Topics do not support the collection of physician prescribing information and are generally unhappy with the way pharmaceutical manufacturers market to doctors and consumers.

"I think it is a very unprofessional, poor practice. With HIPAA [Health Insurance Portability and Accountability Act], there are some real concerns, even though the names are not identified," said Barry Jungwirth, PharmD, BS Pharm, owner of Clark's Rexall Drug in Benson, Minn.

Pharmaceutical firms do not market to physicians as aggressively today as they did in the past. Nonetheless, pharmacists believe that drugmakers can influence doctors to prescribe certain medications.

"I think that brand-name drug manufacturers should market their drugs based on their merit. They shouldn't market them in doctors' offices," said Jim Scanlon, pharmacist at a Target Pharmacy in Lowell, Mass., speaking for himself and not as a Target representative.

"It intimidates or puts pressure on doctors to prescribe something, when [a pharmaceutical rep] says, 'Doctor, you haven't been prescribing that medication,'" said Lynn Hostetler, RPh, owner of Lynn's Pharmacy in Brazil, Ind.

Protected speech?

Ned Milenkovich, PharmD, JD, member at McDonald Hopkins LLC and a legal columnist for Drug Topics, had predicted that the Supreme Court would rule against the state of Vermont.

"The conservative [judges] are going to say this is a bad law and doesn't meet the standard for limiting commercial speech. With restricted speech, costs would increase," Milenkovich said, adding that the Supreme Court ruling will affect commercial speech as a whole and would apply to all types of companies beyond the pharmaceutical industry.

"In a narrow sense, the drug-mining companies will be able to sell this information without a physician signing off on it. The greater impact will be how the Supreme Court goes about determining what is protected commercial speech," Milenkovich said.