Each year, Americans dole out billions of dollars for prescription medications -- and drugmakers dole out billions of dollars to influence the doctors who prescribe them.
The way patients are prescribed those drugs and the role pharmaceutical companies play in the process is at the heart of a fight shaping up in the Minnesota Legislature between a consumer-insurer coalition on one side and a coalition of physicians and drug companies on the other.
On Monday an unusual joint hearing of the Commerce and Labor and the Business, Industry and Jobs committees will begin debate on three bills designed to improve doctors' prescribing skills, reduce the influence of pharmaceutical companies -- and perhaps reduce overall drug spending by consumers.
On one side of the table: those who believe drug industry marketing exerts pervasive influence on doctors, patients and governments, compromising the quality of health care and inflating costs. They claim the drug industry spends $7.2 billion a year on marketing to physicians.
That view is advanced by a newly formed group called the Minnesota Prescription Coalition, a diverse group that includes AARP Minnesota, insurers HealthPartners and Medica, labor unions, hospitals and consumer groups. The coalition supports the proposed legislation.
"If we can save money in the long run and improve quality and safety in prescribing, I think that's a pretty good combination," said Peter Wyckoff, a coalition spokesman.
Opposing the legislation is the pharmaceutical industry and some doctors, including members of the Association of Clinical Researchers and Educators (ACRE), who claim their relationship with drug companies results in better care for patients. The group is co-sponsoring a forum on "Restoring the Value of Collaborative Relationships in Medicine" Saturday in Eagan.
Dr. J. Michael Gonzalez-Campoy, a Minneapolis endocrinologist, past president of the Minnesota Medical Association and ACRE member, says the relationship between doctors and drug companies is often misunderstood by the public.
"We couldn't practice medicine if it weren't for pharmaceutical companies," he said in an interview.
One of the bills calls for the commissioner of Health, along with the state Board of Pharmacy and the University of Minnesota's medical and pharmacy schools, to develop a drug-education program for doctors, pharmacists and other health care professionals. The program embraces "evidence-based medicine," in which doctors make medical decisions based on unbiased scientific information rather than information from drug companies.
Wyckoff claims the pharmaceutical companies employ 90,000 salespeople "who influence doctors' behavior. Every one of them wants to sell their product."
Wyckoff adds that doctors have little time to comb through complicated clinical studies and journal articles, and crave "unbiased" information.
But Marjorie Powell, senior assistant general counsel for the drug industry group PhRMA, says the bill is overkill.
"Right now if insurance companies know there's a generic available, then that's what actually get dispensed to patients," said Powell, who is testifying at Monday's hearing. "Two-thirds of all prescriptions filled in the U.S. are with generic drugs, so it's not clear that an [education] program is of any value to physicians."
A number of states, including Pennsylvania and New York, have adopted similar education programs, as has Australia, which has saved $5 for every $1 invested in the program, according to Stephen Schondelmeyer, a University of Minnesota pharmacy professor who studies drug pricing.
Savings result because these programs often result in cheaper generic drugs being prescribed instead of more expensive brand-name medications.
But that's not always a good thing, according to Gonzalez-Campoy.
"Rising health care costs have focused the discussion away from the value of treatments to the cost of pills," he said.
ACRE doesn't oppose the use of generic medications, he said, adding: "But we're definitely against not using newer, better treatments when they are more appropriate for patients."
Another bill to be discussed prohibits "pharmaceutical data-mining" -- which takes place when drug companies buy doctors' prescribing records from a third party and use the data to target their marketing efforts with individual physicians. Supporters of the bill say this practice can lead to doctors receiving biased information about health risks and can encourage over-prescribing of more-expensive drugs.
But PhRMA's Powell says "because pharmaceutical companies have the most current information about medicines, both new and existing, it's very important that they get that information to the physicians who are actually prescribing the medicines.
A third bill would expand Minnesota's existing law banning gifts to doctors from drug companies. The current law, which requires drug companies to annually report payments to physicians in the state, would be broadened to include payments from medical device companies, as well.
Janet Moore • 612-673-7752