CME

Compliance News in Review, November 24, 2015

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The new nominee to head the FDA faces some tough questions on Capitol Hill, state prosecutors join to investigate potential false claims made by pharmacies, and the AMA institutes a policy calling for a ban on DTC advertising.

Gobble, gobble! Bring on the food coma, it’s Thanksgiving! We can practically smell the turkey and stuffing (or “dressing,” depending on what part of the country you call home) now! While the holiday doesn’t hold the same lore for Hollywood as Christmas, it has inspired at least one memorable sitcom scene. The food, football, parades, family and friends…we’re ready for Thursday! In the meantime, we’ll pass the time with this edition of the Compliance News in Review.

President Obama’s nominee to head the FDA was talking turkey during a recent confirmation hearing. Questions for Dr. Robert Califf were generally tame, but a couple of senators got tough with questions about his ties to the pharmaceutical industry and drug pricing. Senator Elizabeth Warren expressed her concern over what she described as “significant financial support” from pharmaceutical companies that Dr. Califf received while he was a researcher at Duke University. The doctor objected to the idea that the support biased his research in any way, and said copies of industry-funded research contracts would be provided to the committee. Senator Bernie Sanders was the only senator expressing an objection to the nomination, saying the FDA needed a commissioner that would be aggressive in fighting for lower drug costs, and Califf isn’t that person. Much of the discussion focused on the backlog of generic drug approvals at the FDA and Califf agreed that the agency could improve the approval rate.

Federal prosecutors in Florida, California, Texas and Mississippi are gathering around the table with the Department of Defense to investigate fraudulent claims made to the Tricare program by compounding pharmacies. Allegedly, one marketing group went so far as to use social media to promote compound creams to military members and their spouses. In the 2015 fiscal year, Tricare paid $1.75 billion for compounded drugs, which is nearly 20% more than the program paid in 2012 for these drugs.

Time to make a change to the drug marketing recipe, according to the American Medical Association. At an interim meeting of the Association, a policy calling for the ban of direct to consumer (DTC) advertising of prescription drugs in medical devices was adopted. The new policy is based on the idea that money poured into the marketing of drugs is inflating prices, and DTC advertising drives a demand for expensive new medications, which are not always appropriate. In addition to calling for a ban on DTC advertising, the policy will establish a task force focused on lowering the cost of drugs by advocating for more competition in the sector and transparency in drug pricing.

Before we close this edition of the Compliance News in Review, we’d like to take a moment to say how thankful we are for all you, our dear readers. Whether you’re celebration leads you over the river and through the woods, or keeps you closer to your own home, we wish you happy and safe Thanksgiving.

See you in December!

Compliance News in Review, November 16, 2015

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The OIG 2016 Work Plan is released, the House of Representatives form a task force to combat rising drug costs, a Massachusetts HCP is indicted in the Warner Chilcott case, and CMS releases informational charts to help clear Open Payments confusion.

He’s an international man of mystery, who’s licensed to kill, and he is back in theaters for you viewing pleasure. He’s Bond, James Bond. The latest installment of the series, Spectre, has hit theaters. The reviews are mixed, but hey, all we ask out of a Bond film is a good vodka martini (shaken, not stirred), spectacular gadgets, and a good chase sequence or two. Whilst we check local screening times, we’ll leave you with our own top secret document to peruse, this edition of the Compliance News in Review.

For Your Eyes Only, it’s the OIG 2016 Work Plan. Okay, it may not be top secret, but the 2016 plan is out and it reveals some interesting news for pharma and med device companies. You may recall that in the 2015 Work Plan, the OIG said it would review the financial interests reported under the Open Payments Program. In this year’s Plan, the agency has slightly revised this initiative (revision in bold):

“We will determine the number and nature of financial interests that were reported to CMS under the Open Payments Program. We will also determine the extent to which CMS oversees manufacturers’ and group purchasing organizations’ (GPOs’) compliance with data reporting requirements and whether the required data for physician and teaching hospital payments are valid.”

Previously, the Work Plan stated the OIG would review whether the required data was reported “accurately and completely displayed in the publicly available database.”

U.S. House and Senate members have no Quantum of Solace regarding drug prices in wake of some recent high profile drug price hikes. In the House, a group of Democrats have formed the Affordable Drug Pricing Task Force to pursue “meaningful action to combat the skyrocketing costs of pharmaceuticals.” In the Senate, the Special Committee on Aging is set to investigate large spikes in drug prices. The Committee sent letters to Valeant, Turing Pharmaceuticals and two other companies for information regarding recent large increases in drugs sold. The Committee also requested a face-to-face meeting with the CEO of Turing. Both Valeant and Turing have also received subpoenas from federal prosecutors regarding their drug pricing policies.

A Massachusetts gynecologist was indicted on several different charges including a count of violating the Federal Anti-kickback Statute in connection with Warner Chilcott case. The indictment also seeks criminal forfeiture of $23,500. If found guilty, the doctor could face up to 11 years in prison and fines up to $325,000.

CMS won’t Never Say Never Again to the inclusion of Open Payments data on the Physician Compare website , but it is a no for now. After receiving comments and some consumer testing, it was determined the data is different that data presented on the Physician Compare website. CMS will continue to conduct tests with consumers to determine how best to frame the data.

In the past, the hierarchy associated with teaching hospitals has confused The Living Daylights out of reporting organizations that try to determine how to report payments in the Open Payments system. CMS hoped to clear the confusion by providing a couple of during a recent webinar. One chart is intended to help reporting organizations determine when and how to report payments to teaching hospitals. The other is an organizational chart to help show how the various entities roll up to a teaching hospital on the CMS teaching hospital list. Other topics covered during the webinar included record validation changes for 2015, and how to report stock and stock options as forms of payment.

CMS has been working diligently to improve the Open Payments system. The recent news of improvements offers a good reminder for companies to survey their programs, to make sure  all of the pertinent information related to the changes is being communicated. While the process of preparing systems to handle those changes is important, stakeholders such as sales, R&D, and vendors also need to be aware of how those changes affect their interactions with customers. On-going training is critical.

Well, that’s all the compliance news fit to blog for this edition. Have a great week everyone!

The 2015 Pharmaceutical Compliance Congress: A Review

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The Sixteenth Annual Pharmaceutical Regulatory and Compliance Congress, in Washington DC, featured legislators and industry leaders discussing hot topics and best practices to a diverse and rapt audience of compliance professionals.

Annual OIG Update from Mary Riordan

The opening plenary session kicked off with the annual OIG Update, from Mary Riordan, Senior Counsel, Office of Counsel to the Inspector General. In addition to her usual review of recent settlements actions (False Claims and otherwise), and the OIG’s Fiscal Year 2015 Work Plan, Riordan focused on the responsibilities of boards of directors in company compliance functions, and urged the audience to use the OIG’s April 2015 Practical Guidance for Healthcare Governing Boards on Compliance Oversight as a starting point for those expectations. Staying on the topic of board responsibility, she pointed out that prior to her appearance at the conference, Millennium Health LLC had entered into a Corporate Integrity Agreement that requires the company to maintain a majority of independent (non-executive and non-family) directors as part of the settlement.

When stressing that kickback concerns continue in the industry and for her agency, Riordan suggested that attendees “think about the kickback risks associated with financial relationships and strive to identify the relationships that would implicate risks.” What controls are in place? Are those controls meaningful and effective? She emphasized that the OIG was there to help and their goal is “not to collect penalties, rather, it is to encourage companies to comply.”

She also focused on individual accountability and reminded the audience that “individual accountability at all levels of organizations is under fresh scrutiny as the OIG tries to identify individuals responsible for misconduct.”

AUSA Panel

The Assistant US Attorney’s (AUSA) Panel followed with Charlene Keller Fullmer from the US Attorney’s Office in Philadelphia, Jeffrey Steger from the Civil Division of the DOJ, and Kristen Williams from the US Attorney’s Office in Los Angeles, presenting their views on the direction of compliance enforcement. Keller Fullmer said her office continues to see off-label cases focused on kickbacks, particularly with small companies and medical device companies. She pointed out that with smaller companies, pinpointing a paper trail is an easier and less cumbersome process than it is with the larger companies. Following up on Mary Riordan’s comments, she also suggested a review of recent CIAs, and their emphasis on individual accountability.

Williams recited her office’s mantra of “come in, come early, and come often” when discussing how companies should react to an investigation. Demonstrating a robust approach to compliance is critical when she evaluates a compliance program. She recommends a proactive approach, one in which a company responds to issues, before those issues even arise in that company.

For Steger, the key to a successful compliance program is one that involves more than just compliance personnel (a theme throughout the conference). Is compliance part of the company’s culture? Has the company taken proactive steps to initiate and invite feedback, e.g., an 800 number compliance tip line?

FBI’s New Focus on FCPA Investigations

The next plenary presentation was a bit of a twist on the usual agenda, as Jeffrey S. Sallet, National Chief of Public Corruption and Civil Rights for the Federal Bureau of Investigation, offered the update on the Foreign Corrupt Practices Act (FCPA) from the Bureau’s perspective. The focus was on a “five pillars” approach to successful enforcement and according to Agent Sallet, only through a partnership with the public, industry, and other governmental agencies like the SEC, DOJ, and IRS, can the FBI be successful in its goals to encourage a global culture of compliance.

Agent Sallet’s enthusiasm and energy was a tough act to follow and after a break, Thomas Abrams, Director, Division of Drug Marketing, Advertising and Communications, Food and Drug Administration followed up with his annual FDA-Office of Prescription Drug Promotion (OPDP) update. As per usual, Abrams presented a plethora of notes and comments describing the FDA’s efforts over the last year, a high-level review of the document and advertisement submission process and summaries of guidance released and/or updated by his office. These include the 2014 guidance documents on the use of social media.

Abrams closed with a great example of a sales aid that spurred a warning letter from his office. The product being promoted was contraindicated for children under 6 year of age, but the aid included an image of a very young child in its montage of images, and it included no risk information. Seeing such a clear violation provided a concrete and powerful case for why companies need to take the OPDP’s guidance seriously, and regularly test the process for submitting samples through the agency’s email dedicated to that process – ESUB@fda.hhs.gov.

Chief Compliance Officer Roundtable

Following the FDA presentation, a Chief Compliance Officer Roundtable focused on the evolution of compliance programs following the expiration of Corporate Integrity Agreements. CCOs from an array of pharmaceutical companies agreed that while the end of the CIA did not cause drastic changes in their programs, it afforded them the opportunity to expand how they approached topics like training.

One panelist began by stating that on Day 1 following the expiration, there were no public displays and no celebrations, saying “it was business as usual.”

Another panelist recalled that her department was relieved that they could now think beyond four hours of online training and include “short spurts of training throughout the year.” When asked about tracking that training, the panelist admitted that doing so was sometimes a challenge, but the organization was able to “focus on getting back to their true purpose, educating the learners.”

A third panelist brought up the topic of policies and how the shift to a post-CIA environment gave them an opportunity to survey the full staff for thoughts on what works best in compliance polies and subsequently revamp those policies based on that feedback. The company even hired a creative agency to help them create documents that presented policy content in a more graphical and engaging fashion.

The fourth panelist emphasized the importance of developing a risk assessment model and addressing risk-based needs accordingly. Others agreed, emphasizing that they are now using data analytics gathered during the CIA to address those risks.

FCPA Anticorruption Panel

Day 1 closed with a unique twist on the standard presentations, as a panel of in-house and outside attorneys discussed the FCPA through the lens of a hypothetical case. The structure offered a relief from the standard didactic approach to the content, with moderator, Gary Giampetruzzi, Partner at Paul Hastings, guiding panelists through the scenario.

The scenario was structured and branched in a manner that allowed for gray areas and debate as to the best resolution for each question. As an example, when discussing whether post CIA, the Compliance department should be moved back into the Legal department, one panelist avoided what may have seemed the obvious answer of “no,” and stressed that combining the two would be okay if Compliance still had independence despite the structure. An attorney on the panel agreed, especially in terms of the Foreign Corrupt Practices Act, having that independent voice is the key.

US DOJ Civil Section Update

Day 2 started early, with an 8:15 AM update on the DOJ Civil Section from Benjamin Mizer, head of the agency’s civil division. Mizer discussed the growth in qui tam civil cases (FY 2014 saw 469 healthcare-related cases) and presented compelling statistics on the cases involving rewards to relators. In a comment that was prevalent throughout the conference, he reminded the audience of the government’s use of data to expedite investigations and make a decision as to whether or not to proceed.

Update from CMS on Open Payments

The highly-anticipated presentation from Douglas Brown of CMS didn’t disappoint attendees interested in learning details around the data collected and the updates/improvements to the Open Payments system. Brown pointed out that covered recipients with higher counts of payments records were more likely to review and dispute transfers of value, and there were just over 30,000 disputes, equally divided across teaching hospitals, physicians and principal investigators.

On the enhancements front, the agency is focusing on eliminating the character limitations in the system, so email addresses won’t be blocked. The ability to download reported records will also be enhanced to include dispute information and recipients will have the ability to exchange contact information with the reporting entity to further facilitate the review and dispute process.

After providing the audience with a number of reminders, (e.g., device names are now required on submissions, and TOVs to physician-owned distributors are considered indirect payments and must be reported), Brown informed the attendees that the next Open Payments Open Session Webinar is scheduled for Thursday, October 29th.

Qui Tam Panel

The Qui Tam Panel started with Jillian Estes of James Hoyer Newcomer & Smiljanich, PA, reviewing her recent representation of a relator who worked undercover seven years in a pharmaceutical company investigation. Estes used the case to describe who she considered the ideal relator – a principle driven person with a fearless mindset, who is willing to suffer the consequences of a whistle blower. The individual needs to be realistic in expectation and understand that the process is a long one, usually 3-5 years.

Joseph Trautwein, of Joseph Trautwein & Associates LLC, made it clear that the reason potential relators come to him is because they went to their employers first and the situation was not corrected. The panel listed the characteristics of a good whistleblower case:

  • A lie took place
  • A party benefits form the lie
  • The scheme can be easily explained to the government
  • There is enough evidence of misconduct that the complaint will survive a motion to dismiss
  • There is proof of damages
  • It’s a “good story”

Off-Label Communications and the First Amendment

In the final plenary session of the morning, Paul Kalb of Sidley Austin LLP, delved into the Amarin and Pacira lawsuits, whereby the companies presented the argument that criminalizing off-label promotion when it is used to communicate truthful information is unconstitutional. Kalb reviewed the potential ramifications of those cases and closed with the reminder the proverbial jury is still out on how on-going cases will be settled. Based on recent rulings though, we are fast approaching a fork in the road in this core and critical compliance issue.

Mini-Summit: Evaluating Compliance Program Effectiveness

Among the first series of “Mini Summit” breakout sessions, I chose to attend the Evaluating Compliance Program Effectiveness – Board Responsibilities, Board Advisors, and Compliance Experts panel discussion and Q&A.

The first panelist indicated that a good starting point for evaluation of the program is how the company manages high-risk third parties. Are there strong and effective controls in place for third-parties doing business on behalf of the company? Another stressed the need to have outside counsel involved in the program to provide an outsider’s view on the process and the program. A third panelist felt strongly that having people with different backgrounds on the compliance team is important. He also suggested that attendees look at the OIG’s recent guidance for board oversight of the program. “The board needs to demand frequent dialogue,” he said. Another felt that board members have a responsibility to ask questions, review the data, and speak up.

When evaluating training, one panelist emphasized the power of employee surveys to assess whether all participants understood the content of the training. When an audience member asked whether those surveys should be broad or targeted, that panelist said it depends on how each company operates and another added that at his company, they survey the entire employee population.

One panelist also warned the audience about the risk of getting too comfortable in their policies and procedures. New people coming into the company may be coming from a different industry, and may not have had orientation to a compliance program. “Be ahead of the curve,” he said, “when decisions like Amarin come down, you need to be having a conversation.” A fellow speaker followed with the need for an interaction between compliance and the businesses. “It’s important to vet your compliance procedures with the business owners,” he said.

Mini-Summit: Managing Multi-national HCP Meetings

In the Managing Multi-national HCP Meetings: Complying with the Codes and Transparency Requirements session, a panel from around the world discussing the codes and laws relevant to their particular regions.

One industry executive discussed the challenge of holding meetings with physicians from around the world, who each bring their own set of rules from his or her home country. For example, when holding an advisory board with multinational participants, how should meal limits be addressed when those limits vary? The company establishes ground rules but allows common sense to prevail – for example if a limit is slightly above the physician’s home limit, allowing the meals may be a more realistic approach. The executive added that it’s important to create a list of approved meeting places in each country and to train travel agencies on that list.

Hwa-Soo Chung of the Kim & Chang Law Firm in Seoul, South Korea, reviewed the rules in her country, where practices are driven by industry codes with strict limits on speaker meetings no matter where the meeting is held. That severely restricts how much companies around the world can invite Korean doctors to their meetings.

According to Yuet Ming Tham, of Sidley Austin and former Asia-Pacific Compliance Director for Pfizer, “the biggest risks are Korea and China.” The companies she works with will go for lowest meal limit among the group of physicians. In terms of content, companies should always follow the rules of where the meeting is taking place.

Summary

The Sixteenth Annual Pharmaceutical Regulatory and Compliance Congress managed to deliver new perspective and debate on the topics facing the life sciences compliance industry, despite what some attendees described as a lack of new guidance, news or government policies in recent months. Each day of the conference was filled wall-to-wall with the type of keynote speeches, panel discussions and networking opportunities both experienced professionals, and newcomers to the field, need to consider as they strive to create and maintain compelling and effective compliance programs.

Thanks for reading,

Sean Murphy

About NXLevel Solutions

Through its PharmaCertify™ division, NXLevel Solutions helps life science companies build positive compliance cultures and reduce risk through innovative training and communication solutions. Our newest tool, TOVdisclosure.com, is a streamlined and intuitive site that enables manufacturers to share payments information with HCPs and HCOs before data is reported to CMS or other authorities. Contact us or visit TOVdisclosure.com for more information.

Compliance News in Review, October 14, 2015

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A survey of physicians in the UK reveals negative opinions of the pharmaceutical industry, another pharmaceutical company settles kickback allegations with the DOJ, BMS enters into an FCPA settlement, and new legislation aimed at adding to industry reporting requirements is introduced in the Senate.

The boys of summer are singing their swan song. The MLB playoffs have begun! If your team is in the hunt, congratulations, but unless you’re pulling for the Cubs, getting too excited is useless. Robert Zemeckis says the Cubs will take it all, via Back to the Future 2 of course. There’s just one problem though, Miami won’t be the Cubs opponent, as predicted by the film, but hey when one predicts the future, there are bound to be just few hiccups. While we wait to test the accuracy of the director’s clairvoyance, let’s take look at the more recent past, with this edition of the Compliance News in Review.

First up to the plate are a group of physicians who are unhappy with the pharmaceutical industry. A recent survey of physicians in the UK found that almost half of the respondents had a negative opinion of the pharmaceutical industry. The primary reason was the belief the industry focused too much on sales and marketing. Other reasons included the lack of understanding of physician needs and budgetary pressures. The negative view is leading to increased resistance to face-to-face meetings with sales representatives. Ironically, the survey showed physicians who did meet with sales representatives were less likely to have a negative opinion of the industry.

After a meeting on the mound with the DOJ, PharMerica has agreed to pay $9.25 million to resolve kickback allegations. According to the DOJ, the company, which provides pharmacy services to nursing homes, received and solicited kickbacks from Abbott Laboratories in exchange for promoting the use of the drug Depakote for nursing home patients.

After some allegedly foul behavior in China, BMS has entered into a $14 million settlement with the SEC to resolve FCPA charges. The SEC alleged that BMS China sales representatives bribed doctors and then inaccurately recorded the bribes as a business expenses. The SEC claims BMS failed to respond to bribery red flags, and failed to investigate employee claims that fake invoices were being created to hide the bribes.

Industry and physician groups are not happy about a proposal by CMS to include Open Payments data on the Physician Compare website. In July, CMS sought comments on a proposal to include Open Payments data on the Physician Compare website. AdvaMed and BIO both pointing out that the payments would be presented without proper context. PhRMA said that CMS should focus on improving how the data is presented on the Open Payments website before sharing it on another website. The AMA expressed similar sentiments, saying it was opposed to the sharing of data that physicians haven’t validated as accurate, and pointed out there was still much work to be done in this area on the Open Payments website.

Team Sunshine Act is back in the game. Senators Grassley and Blumenthal introduced legislation that will require drug and device manufacturers to report payments and transfers of value to mid-level practitioners. The legislation is called the Provider Payments Sunshine Act, and if passed, would go into effect in 2017. Senator Grassley said the law closes a void in the current requirements, and it would provide a complete picture of the payments provided to healthcare providers. Senator Blumenthal said all providers need to be “held accountable,” and that this level of disclosure is necessary “in today’s world.”

Transparency continues to be a hot topic in the industry, both in the US and abroad. We’ll be watching to see if the law proposed by Senators Grassley and Blumenthal makes it out of the Senate, or if more states take up the initiative to pass laws requiring the reporting of payments to mid-level practitioners.

The evolving nature of transparency laws and requirements requires pharmaceutical and medical device companies to actively train and communicate with employees about what’s expected. Effective training is needed to ensure compliance with the laws and requirements, and, as importantly, to work toward clearer communications between sales representatives and the healthcare providers whose information will be disclosed.

Have a great week everyone!

Compliance News in Review, October 5, 2015

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CMS releases a new teaching hospital list and de minimis thresholds, ICD-10 is launched, New Hampshire investigates manufacturers of painkillers, and the UK Ministry of Justice reverses its position on expansion of the law.

It is fall y’all! Okay, so the stars and the calendar may have said fall arrived a couple of weeks back, but it just doesn’t seem real until we hit October. The air gets a little crisper, the leaves start changing, and we sadly reach that point when we hope against hope that we can make it through the night without turning the thermostat to “heat.”

Before you know it, all the pumpkins and scarecrows will give way to mistletoe and snowmen (insert collective groan here). Before we all run out for the annual jump into the pile of leaves, let’s grab a cup of cider and your favorite pumpkin spice treat, and review all the compliance news fit to blog, with this edition of the Compliance News in Review.

October first was quite a busy day! First, CMS released the teaching hospital list and de minimis thresholds for Open Payments. In 2016, payments to Covered Recipients of $10.22 or higher will have to be reported and the annual aggregate reporting threshold will be $102.99.

Second, Medicines Australia’s new transparency requirements went into effect. Even though the Code of Conduct was effective in May of this year, implementation of the new transparency requirements was delayed until October. One of the major changes in the transparency requirements was the requirement to report at an individual HCP level rather than in the aggregate.

Finally, October 1st was the “go live” date for ICD -10 (International Classification of Diseases, 10th edition). ICD-10 is the set of diagnostic and procedure codes used by healthcare providers to bill insurance providers and government healthcare programs. The transition to ICD-10 was mandated by the Centers for Medicare and Medicaid Services and is intended to provide more detail over the previous coding system. CMS says ICD-10 will help better “accommodate future healthcare needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers.” While specificity can be a good thing, could ICD-10 be taking it a bit far? Check out some of the more unique codes in the new system. A couple of our favorites are “W56.22xA- Struck by an Orca, initial encounter,” (which apparently spawned a whole book) and “W49.01XA Hair causing external constriction, initial encounter,” also known as the Flynn Rider Code.

New Hampshire is turning a cold shoulder to opioid makers. The state’s Attorney General’s Office has announced it will be investigating the marketing practices of several manufacturers of painkillers. The AG’s Office believes the companies may have engaged in fraudulent marketing practices, which may have misled doctors and patients about the addiction risks and effectiveness of drugs.

The UK is changing its colors regarding expansion of the Bribery Act. Prosecutors had been petitioning to expand the law to make it easier to prosecute businesses involved in bribery, but in response to questions from lawmakers about the proposed changes, the Ministry of Justice said it was no longer interested in pursuing the matter. The response said there was “little evidence of corporate economic wrongdoing going unpunished.”

Conflicts or confluence – decisions, decisions. A recent editorial in the Journal of the American Medical Association (JAMA) makes a case for falling away from using the phrase “conflicts of interest” when describing the secondary interests involved in clinical research. The authors suggest “confluence of interest” instead. They say “conflicts of interest” automatically sets up the notion that something wrong is taking place. The authors point out that in academia, notoriety and fame could be a stronger influence on bias than financial reward. Universities, research institutes, the NIH and medical journals can all impact bias.

October has certainly started with a bang, in the world of physician spend transparency, both here in the U.S. and abroad. The news offers a good reminder that transparency and disclosure measures are constantly evolving. Yet another change will be upon us in 2016 with the removal of the exclusion for speaker of faculty payments for accredited CME.

With all of the changes in motion, now is a perfect time to refresh your company’s training on the requirements of the Sunshine Act and Open Payments. Ensuring your team is aware of the changes is critical, and those in the field need to understand the impact the law has on the healthcare providers they interact with on a regular basis.

That’s a wrap on this edition of the Compliance News in Review. Enjoy the cool weather everyone and have a great week!

News in Review, August 11, 2015

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Industry support of CME increases in 2014,  NuVasive settles False Claims charges while Mead Johnson deals with FCPA charges, and Amarin wins a preliminary injunction in its off-label case against the FDA.

The dog days of summer have certainly arrived in most of the U.S. with temperatures that are best described as hot, hot, hot! Thanks to Willis Carrier and his wonderful invention, we can at least find occasional respite from the sun’s rays and the humidity. So while you wait for a break in the heatwave, crank the A/C up a few notches, grab a cool beverage, and just chill with this edition of the Compliance News in Review.

According to a report from the Accreditation Council for Continuing Medical Education (ACCME), industry support of CME increased 2.4% in 2014. According to the report, industry support represented about a quarter of all CME revenue in 2014, whereas in 2007, that support was closer to half (46%) of CME revenue. Physician attendance at CME dropped by just over one percent, but non-physician attendance rose six percent.

The heat is off for NuVasive now that it has settled with the DOJ. The company has agreed to pay $13.5 million to settle charges it violated the False Claims Act by marketing a product for surgical uses for which it was not approved. According to the government, the company marketed its CoRoent System for several spinal surgical procedures for which it was not approved. The DOJ also claimed kickbacks, in the form of speaker fees honoraria, were paid to induce physicians to use the system. The company was also accused of paying kickbacks for physicians to attend events hosted by Society of Lateral Access Surgery (SOLAS), an organization that was entirely organized and funded by NuVasive.

Mead Johnson entered into a settlement with the SEC to resolve charges it bribed Chinese government healthcare workers to recommend its infant formula, in violation of the FCPA. According to the SEC, the company funded the payments through distributor allowance funds paid to a third-party distributor, and then directed the third-party on how those funds were to be used. Allegedly, the payments were not properly reflected in the company’s books and records.

Insys also finds itself in the doghouse; or in this case, we’ll say the duck house (okay, it’s a reach, but stay with us here). Insys Therapeutics has entered into a settlement with Oregon to resolve a deceptive marketing case. The State claims the company marketed an opioid painkiller for treating mild pain that was only approved for treating pain in cancer patients who are not responding to other types of painkillers. The State also claims the company paid physicians for writing prescriptions and used unqualified physicians to promote the product. The settlement will be split between the State and an organization dedicated to the prevention of opioid abuse, which will be selected by Oregon’s Attorney General.

So it appears, this off-label promotion dog can hunt. Amarin, the company suing the FDA over its ability to promote its fish-oil drug for off-label uses, has won a preliminary injunction against the agency. The injunction is not a final order, but for now, the FDA cannot prevent Amarin from the truthful off-label promotion of its product. The drug is approved for treating patients with very high levels of triglycerides. Amarin would like to promote the drug for use with patients that have moderately elevated triglycerides levels, despite being on a statin.

Like the Caronia decision before it, the Amarin case certainly raises interesting questions about the future of truthful off-label promotion. While a compliance training session may not be the place and time to delve into a discussion of that future, the decision does present an opportunity to discuss off-label promotion and how to address questions related to off-label use. Why not take this opportunity to launch refresher training, or distribute an updated, quick-reference communication piece? On-going reminders about what constitutes off-label promotion, and the policies your organization has in place to address unsolicited questions, are part of any effective compliance curriculum. The case also creates an opportunity to work with commercial team managers on a plan to increase the dialogue about the topic with their teams. Off-label is in the news and the training opportunities abound.

Compliance News in Review, June 16, 2015

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Dinosaurs roamed the earth again (at least in the land of movie theaters), over the weekend, with the release of the summer’s first big blockbuster, Jurassic World. You’d think after three films, the characters would have learned not to fool with Mother Nature. Apparently not, and considering the $200+ million the film racked up at the box office, we are not tired of watching them make those same mistakes.

It may not involve death, destruction and extinct creatures, but we have our own epic tale to tell. Break out the popcorn and 3D glasses, and silence your phones please. It’s time for this week’s feature presentation – the Compliance News in Review.

Transparency International is undertaking a project of Giganotosaurus proportions. At the International Pharmaceutical Compliance Congress and Best Practices Forum, Executive Director Robert Barrington spoke to attendees about corruption in the healthcare sector and an initiative underway to evaluate corruption in the pharmaceutical industry specifically. The project will focus on five key areas: procurement and distribution, manufacturing, marketing practices, product registration, and research and development. Barrington noted that the industry should prepare for more scrutiny, with patients demanding to know why increased spending has not led to an improvement in the quality of healthcare.

Public Citizen has accused the FDA of improperly expanding the original approved use of a sleep disorder drug, and has filed a petition with the agency to have the label changed. According to the organization, the drug was initially approved for use in treating the disorder, Non-24, in blind patients, however the drug’s label does not specify the patient population. Public Citizen says this opens the door to the drug being used for other sleep disorders with patients that are not blind. Following the initial approval, the FDA did send the manufacturer a second approval letter which stated a mistake was made and the drug was approved for treatment of Non-24 in general. The second letter notes that the condition is experienced almost exclusively by those who are blind.

Could this be another “blockbuster” decision by the FDA? The FDA sent a letter to Amarin Pharmaceuticals and the court in response to Amarin’s lawsuit against the agency for violating its free speech rights. The company would like to share study information showing its drug reduces the risk of heart attack when taken in conjunction with a statin, which is not an approved use. In its response to the lawsuit, the FDA says it does not have concerns with most of the information the company wanted to share, and it does not consider the sharing of that information to be false or misleading. The letter also reminded the company that new guidelines for sharing off-label information are forthcoming.

In our opinion, the letter from the FDA to Amarin is certainly not an invitation for pharmaceutical and medical device companies to start sharing information about unapproved uses of their products. Situations like this, as well decisions like the Caronia case, may lead some to think the rules have changed, when in fact they have not. Training and communication efforts need to emphasize that the laws and regulations remain the same. Promotional statements still need to be truthful, accurate, not misleading and balanced.

The message should be clear – only company approved studies and statements may be shared, and done so in the way described by the company. The way in which companies play the game may be evolving, but the rules of the game remain the same. Playing within those rules benefits all stakeholders, including the company, and most importantly, the patient.

Have a great week everyone!

Compliance News in Review, May 27, 2015

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Legislation nullifying the need to report payments associated with CME moves to the House of Representatives for a vote, a new article in the NEJM offers thought proving insight on the relationship between industry and physicians, and OPDP issues untitled letters to two pharmaceutical manufacturers.

The monotonous strains of Pomp and Circumstance fill the air…graduation season is here! From kindergarten to college, students are donning caps, gowns, cords and stoles in celebration of their academic achievement. If you happen to have a student crossing the graduation stage this spring/summer, congratulations! We hope the commencement address is at least as thought provoking as this one. While you’re sitting there waiting for your loved one’s name to be announced, feel free to fill the time with this edition of the Compliance News in Review.

The 21st Century Cures Bill graduates from the House Energy and Commerce Committee and moves on to a vote by the whole House. The legislation aims to improve healthcare through support for research and development and by streamlining regulations. If passed, the law would nullify the requirement for reporting payments associated with CME; require the FDA to provide guidance on the sharing of health economic information; and require the FDA to issue guidance on the sharing of truthful, not misleading scientific information about off-label uses of drugs.

A new article in the New England Journal of Medicine explores the relationship between physicians and the industry. The article suggests the need for a reasoned approach when addressing conflicts of interest. The author acknowledges that conflicts exist, but that there are benefits to the physician industry relationship that shouldn’t be discarded simply because such relationships with industry are perceived as a negative.

Over a period of five days, the Office of Prescription Drug Promotion (OPDP) issued two untitled letters. Until this point, the agency had issued only four letters this year. The first letter, issued to Oak Pharmaceuticals, dealt with misleading statements on an exhibit banner. The statements did not include information about risks or material information about the approved indication of the product. According to OPDP, the only reference to prescribing and safety information on the banner was a directive to talk to a representative at the company’s booth.

The second letter was issued to Actavis over misleading statements on a Watson Pharmaceutical product webpage. The OPDP said the webpage was misleading because it contained unsubstantiated claims. The agency cited a specific marketing statement indicating the drug would help with conditions (sleep disturbance and work productivity) for which there was no evidence in the clinical studies.

When training about promotional speech, life sciences companies often focus on off-label statements, and with good reason. Off-label promotion continues to be a dominant issue in False Claims Act cases. However, other promotional speech issues should not be ignored or forgotten. The OPDP has least one letter every month so far in 2015. Additionally, the agency continues to dedicate considerable resources to educate healthcare providers about its Bad Ad program. That’s why promotional speech training needs to go beyond off-label, and address the need for company representatives to present the benefits and the risks of the products they promote.

Enjoy the week everyone!

Week in Review, May 13, 2015

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European Medicines Agency changes its conflicts of interest policy, ACCME updates its requirements related to the disclosure of commercial support, Siemens may be facing corruption charges in China, Bio-Rad tries to block access to FCPA settlement documents, the FDA schedules a summer session with stakeholders to discuss the topic of off-label, and another pharmaceutical company adopts the First Amendment argument in a fight to promote off-label.

Well, the world welcomed a new royal at the beginning of May, and last week, we even learned the name of the latest little princess, Charlotte Elizabeth Diana. A lovely name for a lovely little girl, and a touching tribute to the proud papa’s mother. Of course, if you’re not an Anglophile, you undoubtedly couldn’t care less, so we’ll quickly move on to our own little bundle of joy…the latest version of the Compliance News in Review.

In other news from across the sea, the European Medicines Agency (EMA) has made changes to its conflicts of interest policy. The agency will no longer allow individuals with connections to the pharmaceutical industry, or those who know they will be working for the industry, to sit on drug review panels. The previous policy left that decision up to the individual.

The ACCME has issued a royal proclamation updating its requirements for disclosure of commercial support. CME providers will now be allowed to use tabs, hyperlinks, or other electronic means to communicate commercial support to attendees. The ACCME says the move is an effort to “simplify compliance expectations and make them consistent across activity types.” The organization expects learners, as they always have, to receive disclosure information prior to the start of a CME session.

Siemens announced that its healthcare unit’s marketing and business practices are being investigated by Chinese regulators. The company denies media reports that the investigation deals with corruption, and says that it is working with regulators to resolve the matter. A Chinese government website stated that regulators were not investigating the company over bribery concerns. Siemens sells medical equipment and biochemical tests in China.

Bio-Rad raised the drawbridge on a records request from an investor. That investor has now filed a petition to have access to records related to Bio-Rad’s FCPA settlement. In 2014, the company entered into a non-prosecution agreement with the DOJ and accepted an Order issued by the SEC to resolve the matter. The investor made a request for records that related to the bribery allegations, but the company said there was no proper purpose for the records and the request did meet certain legal requirements.

The FDA will hold audience with the public during the summer to discuss off-label promotion. The agency says the meeting is being called to discuss the issue with a variety of stakeholders. The industry has been vocal about how the regulations infringe on First Amendment rights and have called on the FDA to relax its regulations. Critics worry that allowing companies to promote off-label will lead to less clinical trials and risks to patient safety.

One drug maker has decided to not wait for that summer meeting to take action. Amarin Pharma has filed suit against the FDA over its ability to share off-label information with physicians. Lawyers representing the company say the company is within its First Amendment Rights to share the information, as long as it is truthful and not misleading. The lawyers believe Amarin is the first company to pre-emptively sue the FDA over the issue. At the center of the suit is the company’s ability to share company-sponsored clinical trial information with doctors. The information indicated that the drug may be helpful for a wider patient population than what was approved. Lawyers for the company say the company knows physicians are already prescribing the drug off-label for a wider patient population, and more information, not less, should be shared with the physicians. A director with the health advocacy group, Public Citizen, says if the suit succeeds, it will undermine the FDA’s drug approval process. The FDA had no comment.

With that news of the on-going battle over off-label, we proclaim this issue of the Compliance News in Review as complete. Clearly, the focus on off-label isn’t going away anytime soon. That’s why we continually update our PharmaCertify eLearning module, On-label Promotion, with the content your representatives need to stay in compliance as they interact with HCPs.

Have a great week everyone!

News Week in Review, April 13, 2015

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Spain and Malaysia amend their anticorruption laws, researchers from the NIH say the government rules on paperwork and travel are too complex, and India considers dedicated oversight for medical device.

Golf voices and claps only, please. It’s time to celebrate the greenest spectacle in sports – the Masters. The lush fairways, that somewhat disturbing green jacket and we can’t forget the green ($10M total) won by the top players. This year’s event saw the return of Tiger Woods, Jack Nicklaus making a career first hole-in-one at the Par 3 tournament, and the record breaking victory by Jason Spieth. Now that the drama is over and the young man from Texas held off the field, it’s time to tee off on this week’s Compliance News in Review.

A pair of countries legislating compliance programs are the first on the tee this week. At the end of March, the Spanish Congress approved amendments to its Criminal Code, which requires companies to adopt a compliance program. The change is effective as of July 1, 2015. According to the law, compliance programs must be supervised by a group or individual that can exercise a high level of control. The law provides a company protection from criminal prosecution when the company’s compliance program when the individuals responsible for the compliance program did not neglect their duties. It also details six element’s that must be included in order for the company to be protected from prosecution.

Malaysia’s Attorney General wants to amend country’s current anticorruption law to address corporate liability. A deputy with the Malaysian Anticorruption Commission (MACC) said the U.K. Bribery Act and FCPA were being used as guidelines for the Malaysian law.

Medical researchers from the National Institutes of Health (NIH) would like a mulligan, of sorts, on the paperwork required for travel to attend medical conferences. Researchers say the government’s paperwork and travel approval process is time consuming and is hurting science and it can take up to six months to learn whether they’ve been approved to travel to conferences and meetings. The strict rules were put in place following a scandal involving travel at the General Services Administration. One researcher said he had to turn down a speaking request at a popular conference because the agency has to limit how many individuals it sends to any one event, and he is often passed over as a speaker because conference organizers don’t believe he’ll be able to attend. The NIH spent over $14 million in oversight of travel and expenses in 2014, which was nearly a quarter of its total travel budget for the year.

India is bringing medical device oversight on par with how drugs are regulated. A government task force is recommending a separate regulator be put in place to oversee safety and price controls of diagnostic equipment, implants and hospital equipment. Currently, devices are regulated under the same act as drugs, but both industry and public health advocates have argued that devices are different and should be regulated under different rules.

With that, we put a bow on another year of the “tradition unlike any other,” and another edition of the Compliance News in Reviews. Have a great week everyone, and as you hit the greens this year, remember the words of the late, great Paul Harvey, “golf is a game in which you yell ‘fore,’ shoot six, and write down five.”