Last month, the Office of the Inspector General, Department of Health and Human Services (DHHS) issued a "Special Fraud Alert" targeting aggressive drug industry marketing involving cash and other payments to doctors and pharmacists to promote specific products. The Inspector General warned that such schemes may be in violation of Medicare and Medicaid anti-kickback laws (American Medical News, 29 August 1994). DHHS is concerned that aggressive promotional incentives could harm patients if they influence doctors to make medically inappropriate prescribing choices.
The alert spotlights three different marketing programs. The first involves payments made by drug companies to pharmacists to persuade doctors to switch prescriptions from a competitor's drug to one of its own. One example of the so-called "bounty" scheme involved Miles Incorporated paying pharmacists $35 each time they got a doctor to switch a patient to the Miles anti-angina drug Adalat CC from Pfizer's rival drug Procardia. The pharmacist "bounty" programs are so pervasive that the Attorneys General of 20 states have asked FDA Commissioner David Kessler for his help in stopping the practice (Scrip, 9 September 1994).
The second marketing effort features a drug company awarding doctors "points" towards a free airline ticket each time they complete a questionnaire stating they had newly prescribed the company's product. In 1993, Ayerst paid $830,000 to settle civil and administrative claims arising out of such a "frequent flier" program involving 20,000 doctors.
In the third scheme, drug companies make substantial payments to doctors which are labeled "research grants." In return, the doctors have only to make brief notes about treatment outcomes. In August, a federal grand jury charged one drug distributor, Caremark International, with kickbacks involving the human growth hormone, Protropin. The grand jury charged that Caremark paid hundreds of thousands of dollars to a Minneapolis doctor disguised as research grants and consulting fees in return for his prescribing Protropin.