Pharmaceutical Compliance Congress

Compliance News in Review, February 15, 2016

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Ah, l’amour! It is the stuff of literature, song, poetry, and this time of year, greeting cards galore. Some might refer to Valentine’s Day as a “Hallmark Holiday,” but any day that makes the consumption of chocolate practically mandatory is okay by us. Valentine’s Day…a day to do something special for that special someone and/or the special people in your life. While it may not be as exciting as the dozen roses or heart-shaped box of candy you received, we offer a valentine of our own, with this edition of the Compliance News in Review.

If the cliché, “sharing is caring,” is true, CMS is ready for life sciences companies to commence with their annual caring. The Open Payments system is now accepting registrations, registration certification, and data submissions.

Sweet nothings, or any other comments for that matter, were definitely not whispered by Martin Shrkeli at a recent Congressional hearing into extreme drug price increases by his former company, Turing. Shrkeli was questioned and lectured by members of Congress, but he continually stated that he was invoking his Fifth Amendment right to not incriminate himself by testifying. Following the hearing, he took to Twitter, where he referred to the members of Congress as “imbeciles.” Valeant Pharmaceuticals CEO, Howard Schiller, did testify, and spoke of efforts his company was making to respond to the outrage over extreme price increases.

We just received a veritable bouquet of bills from the Senate Health, Education, Labor, and Pensions (HELP) Committee. The Committee passed seven bills as part of the House of Representatives’ 21St Century Cures. The seven bills are intended to increase funding for medical innovation and streamline requirements for new drug approvals. HELP members spend the better part of year deadlocked over increased NIH funding and regulatory changes for drug approvals, so chairman Lamar Alexander created the smaller measures to move the process forward.

It’s all candy hearts and flowers now between SciClone and the SEC. The company reached a $12.8 million settlement agreement with the SEC to resolve allegations it violated the FCPA. The DOJ chose not to pursue charges following its investigation. The allegations centered on the company’s actions in China. The government claimed the company provided gifts and travel for corrupt intent, failed to conduct proper due diligence of travel vendors who were used to funnel bribes to government officials, and failed to conduct an effective internal investigation when t learned of instances of bribery.

The SciClone case points out the need for a robust anticorruption program. SciClone employees provided gifts, travels and expensive meals to government officials and their family members with a corrupt intent, and a vendor provided bribes as well. Due diligence and proper monitoring are key pieces of any anti-bribery program, but so is training. In-depth anticorruption training needs to be deployed to employees, vendors, and any third-party agents conducting business on the company’s behalf. Anyone who represents a company must understand who is considered a government official, what constitutes a bribe, and the types of activities that raise red flags. This is particularly important for pharmaceutical and medical device companies since healthcare professionals may fall under the broad umbrella of a government official. The feds are adding additional headcount to focus on FCPA investigations, so now is the time to evaluate, re-energize, and re-boot anticorruption training.

Have a great week everyone!

Compliance News in Review, February 1, 2016

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It’s Super Bowl week! Another season of ups, downs, highlights, lowlights, hope, and unfulfilled expectations for fans around the country (except for those lucky enough to root for the winning squad) is about to end. Now we’re left to fill a long seven month void until training camp begins anew and hope springs eternal (we know, we’ve mixed our sporting metaphors). Whether you’re pulling for the Broncos or the Panthers, or just a strong lineup of new commercials (spoiler alert), the day is bound to deliver cheers, groans, and snacks aplenty. Before you dive into the game preparations, we offer a playbook of our own, with this edition of the Compliance News in Review.

We kickoff this edition with news from the expanding world of federal oversight. The DOJ announced that it is adding some muscle to the huddle, and bolstering its anti-corruption resources, by hiring ten new prosecutors for its FCPA unit.

It’s time for a regulatory end zone dance in Kentucky. State Attorney General, Jack Conway, has entered into settlements with Endo and Johnson & Johnson over accusations related to the companies’ marketing practices. The state settled with Endo for $24 million over its marketing of OxyContin. The suit accuses the company of positioning the drug as “non-addictive” and encouraging reps to tell doctors it was less likely to be abused than other opioid drugs. The settlement will be used to fund addiction treatment programs. The state settled with Johnson & Johnson for $15.5 million over the marketing of Risperdal for unapproved uses.

The physician leading the charge for a Sunshine Act in Scotland says the public consultation on his petition to Parliament is “unbalanced.” Dr. Gordon, a former National Health Service psychiatrist, says that Parliament is not presenting full information about the current status of the disclosure of payments from life sciences companies to NHS workers. He says information being presented to the public implies that current disclosure rules may be working and sufficient. The doctor claims the evidence presented in his petition shows that payments are escaping current disclosure requirements. Twelve public discussion groups have been held to discuss the matter and more will be scheduled.

The news on the Final Rule is finally off the bench! At long last, the Average Manufacturer Price (AMP) Final Rule has been released. Included in the new rule is language now excluding sales to 340B covered entities from AMP and Best Price (BP); and revised language regarding the exclusion of patient coupons, vouchers and free goods from AMP and BP. In other news from CMS, the Open Payments system is now ready to begin accepting registration, recertification of registration, and data submissions from applicable manufacturers and GPOs. Data submissions for the 2015 calendar year are due March 31st.

Has the ruling on off-label promotion been reversed upon further review? In proposed jury instructions at the trial of a medical device company and its chief executive, the DOJ indicated that it is “not a crime for a device company or its representatives to give doctors wholly truthful and non-misleading information about the unapproved use of a device.” Does this change the off-label playing field?

Before choreographing an end zone dance of our own over the last bit of news, we have to think about what it really means and whether anything really changes. For trainers, probably not. Even if the government is ever so slightly agreeing that truthful off-label speech is lawful, the fact remains, untruthful off-label speech is illegal. Therefore, now is not the time to abandon or diminish on-label training. Your training must still cover the illegal nature of off-label speech, and the proper handling of off-label inquiries. The importance of vetting promotional statements before they are shared with HCPs or the public must still be stressed.

Well, that’s a wrap for this edition of the Compliance News in Review. If you have a side in the big game, good luck!

The 2015 Compliance Year in Review (and Look Forward to the Rest of 2016)

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The start of 2016 may be filled with hope for good compliance-related news to come, but before we travel too far forward with our prognostications, let’s take a look back at some of the stories that really struck a chord in 2015. Charge up your flux capacitor everyone, as we travel back a few weeks and months, with this edition of the Compliance News in Review: the Yearly Edition.

In 2015, a full year’s worth of data was submitted to the Open Payments program. Considering the rejection of massive amounts of 2014 data, as well as the registration issues and delays that plagued the first Open Payments data submission period, system users certainly had cause to be concerned about the 2015 period. Happily, CMS made improvements, and the process, while not problem free, was smoother in 2015. The agency improved its validated physician list for manufacturers and its data matching processes, which resulted in fewer records being rejected. The improvements in the registration process seemed to help manufacturers, but did little to improve the physician experience.

CMS announced additional improvements that will hopefully improve users’ experience in 2016, including the removal of limitations around entering special characters in text fields, and improving users’ downloading capabilities.

The life sciences industry certainly pushed the free speech issue with the FDA in 2015. Two companies filed suits against the agency, arguing that they had the right to truthfully promote drugs for off-label uses. In the Amarin suit, the court granted an injunction, and the company is free to promote the drug for use in a wider patient population than the drug was originally approved.

On the heels of that case, Pacira filed suit over the FDA’s insistence that the company was promoting a pain killer for post-surgery pain, an unapproved use.  After the company received a warning letter, stating that drug was only approved for use following a specific type of surgery, Pacira argued that the FDA was illegally trying to narrow the approved use. The company also argued that even if it was promoting the drug for an off-label purpose, it had the right to do so, as long as it was sharing truthful information. The FDA quietly removed the warning letter from its website and eventually settled the case.

After years of chatter, but very little visible action, the Serious Fraud Office entered into its first deferred prosecution agreement with a corporate entity, over violations of the U.K. Bribery Act. Standard Bank was accused of failing to prevent bribery by an allied person. The DPA remains in effect for three years and requires the bank to pay $32.6 million; submit to a review of its anti-bribery policies by an independent reviewer and make any changes recommended by the reviewer; and cooperate with authorities in any other matters that arise from the indictment.

The year was devoid of multi-billion dollar settlements in the industry, but 2015 did see the largest settlement by the OIG under its civil monetary penalty authority. The OIG settled with Sandoz for $12.64 million over allegations the company submitted inaccurate ASP data to the Medicare program. The agency alleged that the company submitted inaccurate data between 2010 and 2012, which “undermined the integrity of the Medicare Part B drug pricing system.”

Any worthwhile year-end retrospective needs to include a look forward. So here are the issues that we think will be hot topics in 2016:

  1. Drug pricing transparency. In 2015, several states proposed laws that would require companies to disclose costs for drugs that run in the thousands of dollars per-dose or course of treatment. This push isn’t likely to go away, considering recent dramatic drug price hikes by companies like Valeant and Turing, which resulted in inquiries by lawmakers in the latter part of the year.
  2. Transparency in Europe. Staying on the transparency theme, we expect physician spend reporting in Europe to be a prominent news story toward the middle of the year. The first round of reporting under the EFPIA Transparency Code is due then, and the first round is sure to be thoroughly dissected and analyzed.
  3. Individual accountability. In September of 2015, the Department of Justice released a memo from Deputy Attorney General Sally Quillian Yates saying the agency plans to focus on holding individuals accountable in cases of corporate crime. Not exactly earth shattering news, but the DOJ has put it in writing, so they must really, really mean it. Whether the agency brings a case against an individual in 2016 or not, the policy is sure to be widely discussed by federal prosecutors and other agency representatives at conferences throughout the year.

Have a great 2016 everyone! We’ll see you at CBI’s Pharmaceutical Compliance Congress January 26 and 27.

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!

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, July 20, 2015

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The House of Representatives passes the 21st Century Cures Act, two companies settle AMP charges, oral arguments begin in Amarin v. FDA, and CMS updates its Open Payments FAQs.

Diamonds are not only a girl’s best friend…a very special mouse is fond of them as well. The Happiest Place on Earth (or, at least the one in California), is celebrating its diamond anniversary. Happy 60th Disneyland! The place has certainly changed in its 60 years, but fan favorites such as Mr. Toad’s Wild Ride and the Jungle Cruise have stood the test of time. In true Disney fashion, the party isn’t just a one day affair; it actually started back in May and will likely continue through the fall, if not into 2017. Before we cut the cake with the big ears, we have a bit of “magic” of own to administer. Grab a churro and settle in for this edition of the Compliance News in Review.

The House is celebrating the overwhelming passage of the 21st Century Cures Act. The bill is designed to fund research and change the FDA’s drug and device approval process. It includes a change to the rule its provisions are changes to the Sunshine Act which would exclude the reporting of the value of journal reprints and payments for CME.

AstraZeneca and Cephalon may be feeling a bit Grumpy. The two companies reached separate agreements with the government over charges related to underpaid Medicaid rebates. According to a whistleblower, the companies improperly reduced the Average Manufacturers Price (AMP) of their products by subtracting fees paid to wholesalers. The companies paid $46.5 million and $7.5 million respectively to settle the matter.

Oral arguments began in Amarin’s suit against the FDA. The company cited the Caronia decision and the Sorrell v. IMS decision in its argument. Much of the discussion centered on the type of disclaimers need to accompany off-label promotion and not whether Amarin even has a right to do so. The FDA’s lawyer argued the interpretation of the Caronia decision should be very narrow but the judge disagreed. A judicial order is expected in a few weeks.

The whistleblower in a case against Endo may be throwing a Mad Tea Party now that she’s been awarded $33.6 million for her efforts. The case, which was settled with the government in February of last year, involved the off-label promotion of the company’s pain patch. Despite a recommendation from government lawyers that the whistleblower receive 19% of the settlement, the federal judge awarded her 24%, citing her “extraordinary effort” in the case. The whistleblower initially filed suit in 2005, and spent five of the nine years that followed working under the direction of the FBI.

CMS has sprinkled some Pixie Dust over the Open Payments FAQs, and sure enough new FAQs have taken flight. Several of the new FAQs have to do with physicians and teaching hospitals being able to access, review and dispute the data now that the review and dispute period has closed.

If the FAQ updates weren’t enough, CMS was back for a second ride with updated information about the reporting of CME payments on the Law and Policy page of the Open Payments website. Beginning in 2016, manufacturers will have to report indirect payments to CME providers if the manufacturers learn the identity of the physician attendees or speakers within the reporting year, or the first two quarters following the reporting year.

The updates to the Open Payments website remind us that the program is evolving. Your company’s training needs to evolve and grow as well. Affected personnel need to be updated on changes, and reminded of the need to communicate with their physicians. Now is the time to map out your plan for refresher training and refocus your aggregate spend and sales personnel.

That’s a wrap on the compliance news fit to blog for now. Have a great week everyone.

 

 

Compliance News in Review, June 29, 2015

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The universe has spoken – summer is officially here. (If you’re living in a part of the country that is in the midst of a heatwave, I’m sure you’re thinking “never mind what the calendar says, summer has been here for two weeks!”) Now that we’ve crossed the solstice for another year, let’s take a look back at how spring ended, in this issue of the Compliance News in Review.

PetroTiger escaped the heat of an FCPA prosecution. In a highly unusual move, the DOJ announced it would not charge the oil company with violating the FCPA. Three company executives have already pled guilty to the same charges, and typically charges against the company follow. In this case, the DOJ decided otherwise, saying PetroTiger had fully cooperated with the investigation.

The Sunshine Act is never far from the minds of physicians, no matter the season. 100 physician organizations sent a letter to Representatives Richard Michael Burgess and Peter DeFazio expressing support for a bill that would exempt payments for CME and educational materials from the Sunshine Act. The Representatives introduced the bill in an effort to correct the “unintended consequence of over-burdensome reporting requirements that made access to educational materials for physicians difficult to obtain.” The physician groups claim that the dissemination of medical education materials has already slowed as a result of the law.

The sun has set on an off-label marketing case for a former Merck company. The company settled with the government for $5.9 million in an illegal marketing case involving its former Inspire Pharmaceuticals unit. According to prosecutors, Inspire claimed its pink eye drug was effective for treating blepharitis, a condition for which the drug was not approved. According to the government, the promotion of the drug for the off-label use led to false claims being paid by government healthcare programs. Merck claims the activity occurred before it acquired the company. Inspire was sold to Akorn in 2013.

FDA officials shed some light on advertising and promotion enforcement at the 2015 Develop Innovate Advance conference. Deborah Wolf of the Division of Premarketing and Labeling Compliance discussed several promotional issues surrounding devices, including the risk of physicians promoting devices for unapproved uses.

Tom Abrams of the Office of Prescription Drug Promotion said the most common areas of enforcement for his office involved unsubstantiated superiority claims; overstatement of efficacy; and omission and minimization of risk information. Lisa Stockbridge of the CEBR’s Advertising and Labeling branch said that biologics faced many of the same issues as prescription drugs. She referenced an untitled letter sent to a company for claims made by the company’s CEO in a video interview posted on the company website, which included unsubstantiated claims about one of its products.

Obviously, product promotion remains a hot topic, and with good reason. As we continue to see in the news, off-label promotion violates the FDCA and implicates the False Claims Act, and can result in pretty hefty penalties. However, training needs to go beyond on-label promotion, and cover the topics referenced in the stories above. Misleading statements, false efficacy claims, and omission of risk lead to untitled letters from the FDA, and as seen in the 2014 Shire case, can be used by the DOJ in cases against manufacturers.

All facets of promotional speech need to be covered in your compliance training, especially since the FDA has essentially deputized healthcare professionals to be on the lookout for promotional speech missteps through their Bad Ad program. More and more eyes are focused on product promotion, so making sure everyone responsible for making promotional statements, in any form, is aware of the requirements, is more critical than ever.

That’s the news for this edition. Stay cool and have a great week everyone!