Free Pharma Meals: NPs, PAs Will Get the Same Scrutiny as Docs

James F. Sweeney

Disclosures

July 01, 2019

All of that combines to make NPs and PAs attractive targets for pharma reps. As a 2014 article on pharma industry news site FiercePharma put it[4]:

As physicians pack up camp and move to larger healthcare systems, restrictive policies bar reps from calling on doctors and face-to-face conversations dwindle. But companies may want to invite other members of the office to the marketing party—and send specialized reps to offer a few favors.

Are Physicians Affected When NPs or PAs Receive Freebies?

Should physicians care if their employed PAs or NPs are receiving benefits from pharma reps and device makers?

It depends on whom you ask.

I think it's ridiculous to even think that these highly trained professionals are going to be influenced by a 23-year-old drug rep.

"I think it's ridiculous to even think that these highly trained professionals are going to be influenced by a 23-year-old drug rep," says Price.

Price and other physicians have questioned the necessity of the Sunshine Act and denied that they or the NPs and PAs in their practices could be influenced by a lunch of free pizza or a speaking honorarium.

However, study after study has shown that pharma gifts, even small ones, have an effect on prescribing behavior. A 2016 report published in JAMA Internal Medicine found that physicians who received a single meal promoting a drug of interest had significantly higher rates of prescribing the drug.[5]

And a 2017 study published in JAMA found that physicians who worked for academic medical centers that restricted pharma rep visits tended to order fewer promoted brand-name drugs and used more generic versions instead.[6]

An instance of corruption in this arena has been reported. In 2015, an NP in Connecticut pleaded guilty to taking kickbacks from the manufacturer of a drug used to treat cancer pain. In return, she prescribed the drug for patients who did not have cancer. The manufacturer paid her to be the speaker at more than 70 dinner programs, many of which were attended only by the NP and a pharma sales rep.[7]

Experts also reject the argument that face-to-face interactions with pharma reps are necessary to get information about new drugs.

There are other sources of information, such as medical associations, newsletters, and online courses, that don't pose the same danger of bias, said Joseph Ross, MD, MHS, an associate professor at Yale School of Medicine's Institute for Social and Policy Studies who has studied the relationship between the pharmaceutical industry and healthcare delivery.

Has the Sunshine Act Been Effective?

Although the Sunshine Act has made public the gifts from the industry to physicians, it certainly hasn't stopped them. Total reported giving (general and research payments) was $8.01 billion in 2014, the first full year the law was in effect. In 2017, the most recent year for which records are available, that amount was $8.31 billion. (There is no available figure for the benefits NPs and PAs received.)

The effects of the public disclosure are still being studied.

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