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A Push for Greater Transparency on Big Pharma Payouts

Drugmakers disclose their payments to doctors, dentists, even chiropractors. But spending on nurse practitioners and physician assistants is excluded. Legislation in the Senate would change that.
(Photo: lenetstan/Shutterstock)

(Photo: lenetstan/Shutterstock)

A bill proposed Wednesday by two United States senators would require drugmakers and medical device manufacturers to publicly disclose their payments to nurse practitioners and physician assistants for promotional talks, consulting, meals, and other interactions.

The legislation would close a loophole in the Physician Payment Sunshine Act, which requires companies to report such payments to doctors, dentists, chiropractors, optometrists, and podiatrists. Companies have so far released more than 15 million payment records, covering August 2013 to December 2014.

As ProPublica and NPR reported in July, the 2010 law doesn’t include nurses with advanced degrees or physician assistants, even though they, too, can prescribe medications and some have gotten in trouble for accepting kickbacks.

The bill, introduced by Senator Charles Grassley (R-Iowa) and Senator Richard Blumenthal (D-Connecticut), would expand the disclosure requirement beginning in 2017 to include physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives.

Nurse practitioners and physician assistants wrote 15 percent of all prescriptions nationwide in the first five months of this year, according to IMS Health, a health information company.

“We think that the void should be filled in order to have a complete record,” Grassley said in an interview. “Transparency isn’t an end to itself. Transparency is meant to bring accountability.”

Because the data isn’t publicly reported, it’s unknown how much money these professionals receive from makers of drugs and medical devices, or whether that figure has increased since disclosure of payments to doctors was required. But in recent years, a few non-doctors have been criminally charged with taking kickbacks from industry.

A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000 from Insys Therapeuticsin exchange for prescribing its high-priced medication Subsys to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative.

And in 2012, a physician assistant in Rhode Island was sentenced to six months in prison and six months of home confinement after pleading guilty to taking kickbacks from a medical device company. The company paid him $50 to $300 for each bone growth stimulator ordered by the surgeon he worked for—all told, some $120,000 between 2004 and 2011. The company, Orthofix, and several of its officials also pleaded guilty to charges including fraud, obstruction, kickbacks, or perjury.

Blumenthal, the new bill’s co-sponsor, said the Connecticut case was “a clear, loud alarm bell.”

“Doctors need to be held accountable, but so do all the other providers,” he said. “Requiring these companies to disclose gifts and payments made to other health care providers, not just doctors, is absolutely necessary in today’s world.”

Allan Coukell, senior director for health programs at the Pew Charitable Trusts, said that when the initial Sunshine Act was drafted, nurse practitioners weren’t part of the discussion.

“It’s an important step,” Coukell said of the new legislation, called the Provider Payment Sunshine Act. “Nurse practitioners and physician assistants write a lot of prescriptions, and this creates a level playing field with the same kind of transparency as the original Sunshine Act created for physician payments.”

A ProPublica analysis of prescribing patterns in Medicare’s prescription drug program, known as Part D, found that nurse practitioners and physician assistants wrote about 10 percent of the nearly 1.4 billion prescriptions in the program in 2013. They wrote 15 percent of all prescriptions nationwide (not only Medicare) in the first five months of this year, according to IMS Health, a health information company.

For some drugs, including narcotic controlled substances, nurse practitioners and physician assistants were among the top prescribers.

Supporters of the new bill declined to handicap its chances of passage.

Separately, a bill called the 21st Century Cures Act, which passed the House of Representatives in July, includes provisions that would water down disclosure requirements in the Sunshine Act. Intended to speed the development of new treatments, the Cures Act would exempt companies from having to disclose the value of medical journal re-prints and textbooks they give to physicians (they currently have to disclose them), as well as payments for continuing medical education and speaking engagements that do not promote a particular product.

The Centers for Medicare and Medicaid Services, which aggregates the industry disclosures and releases them once a year, said it does not comment on pending legislation. The American Association of Nurse Practitioners, a trade group, said it doesn’t yet have an opinion on the issue.

This post originally appeared on ProPublica as “Bill Would Add Nurses, Physician Assistants to Pharma Payments Database” and is re-published here under a Creative Commons license.