DRUG UTILIZATION REVIEW CAN BE "WEAPON" AGAINST GOVERNMENT INTRUSION, AMA's TODD TELLS PMA; CALLS FOR JOINT EFFORT IN DUR, CME, AND ANIMAL R&D

A cooperative lobbying effort by the medical profession and the drug industry to fashion a favorable federally mandated drug utilization review program could make DUR a "weapon" against further government "intrusion" into prescribing practices, American Medical Association Exec VP James Todd told the Pharmaceutical Manufacturers Association annual meeting in Scottsdale, Ariz. April 29. "Drug utilization review if done in a responsible fashion, cooperatively, between the pharmaceutical industry and the medical profession could turn out to be one of the best weapons we have against the intrusion into the practice of medicine and the development of ethical drugs," Todd declared. Todd suggested that DUR "certainly will be helpful in trying to do away with the recurring issue of triplicate prescriptions and also the tendency sometimes to underprescribe certain useful medications." Last year's Medicaid drug price rebate law establishes a Medicaid drug utilization review program beginning Jan. 1, 1993. PMA President Mossinghoff noted the association currently is "working closely" with both the American Pharmaceutical Association and AMA on the issue. AMA and APhA leaders reportedly met about three weeks ago to get the DUR effort under way. In addition, Mossinghoff reported that the PMA board of directors has formed an ad hoc committee chaired by Syntex Chairman and CEO Paul Freiman that will focus on drug utilization review. "That's the importance the board placed on that [issue]," Mossinghoff pointed out. He indicated that PMA anticipates additional hearings on DUR before Sen. Pryor's (D- Ark.) Special Committee on Aging. Although Todd called on PMA support in the areas of DUR, physician continuing medical education and animal research, he prefaced his remarks with a veiled warning to the drug industry not to take AMA's blind support as a given for all issues, especially those with little chance of success. Quoting the homespun political wisdom of the " junior senator from Montana," Sen. Burns (R), Todd began his speech with several political maxims, including "never oppose the inevitable, because it is going to happen anyway." Todd said the "new" AMA plans to limit its battles, "which will allow us to do fewer things better," and avoid what he called the politics of confrontation. "Success," he said, "will come through coalitions, accommodation, negotiations, occasionally compromise and all the while remembering there is a part beyond which we cannot go and still maintain . . . our professionalism." The challenge for PMA and the AMA in the DUR arena, Todd said, will be to develop "acceptable principles of drug utilization review, avoiding bureaucratic hassles." Such principles, Todd said, "will lead to the improved quality of care and [assure] the appropriate prescribing of drugs." Todd acknowledged that physicians with the help of the pharmaceutical industry have been "very successful in medicalizing America." He noted that patients today "often feel dissappointed not to leave the doctor's office with a prescription in their hands. However, he suggested that physicians, "mainly because of the rapidity in which you folks bring out new drugs, have a continuing need to learn more and more about the effective use of some drugs, and drug utilization review, although not necessarily well liked, may be one of those universal ways of making sure that happens." PMA and AMA need to be "deeply concerned about the restraint and over-regulation" by the federal government "because they only see the dollars," Todd contended. He maintained that the federal government's approach to DUR has been focused "wrongly . . . as a way to reduce health care expenditures." Todd suggested that if DUR is done "correctly" it "ought to discourage underprescribing as well as overprescribing and all the while improving the quality of care that is given to the people of this country." Todd applauded the PMA for "promptly adopting" the AMA's guidelines on gift-giving to physicians last December, the week before Sen. Kennedy's (D-Mass.) hearings on drug industry marketing practices. Todd said he recognized that the guidelines "weren't greeted with any sense of enthusiasm." However, he declared, "not only did you recognize [the] perception [of industry marketing practices], by [adopting the guidelines] you demonstrated your commitment to professionalism and avoided the almost certain legislation that could have hobbled your future participation in the education of physicians." "Some inducements" offered by drug companies to physicians "seemed inappropriate to professionalism," Todd declared. But now that PMA has adopted the guidelines, Todd said, the PMA/AMA joint commission on industry-sponsored continuing medical education programs "can now move forward in new directions to assure your vital desire and need to be sure that physicians have legitimate continuing medical education." Guidelines for CME programs were adopted by the Accreditation Council for CME in mid-March. The AMA official issued a warning to the pharmaceutical industry not to be complacent on the issue of using animals in biomedical research. The biomedical community, Todd said, "has been slow to recognize the threat" posed by the animal rights activists. "We are in a war to control the philosophy in this world about the contribution of animals to society," he declared. He noted that the PMA and AMA "have developed a broad-based action plan calculated to educate professionals and the public as to their stake in the problem and to ask them to speak out." Todd asked for more financial support for the educational effort, noting that "few have come forward with any tangible support." AMA reportedly has been seeking about $ 1 mil. from PMA to help fund workshops on the animal testing issue. He pointed to "competing agendas and poor coordination for the poor showing of support.