AMA Eyes PBMs, Formularies, Unused Drugs

Article excerpt

Physicians should not sell nonhealth-related goods from their offices, the American Medical Association house of delegates declared at its annual meeting in Dallas last month.

The only small exception to this rule would be the offering of low-cost nonprescription goods for the benefit of community organizations, such as the Boy Scouts or Girl Scouts. In such cases, physicians must not profit and patients must not feel pressured to buy, the house declared.

The policy, based on a report of the AMA's Council on Ethical and Judicial Affairs, did not address the question of physicians selling health-related products, such as drugs or dietary items. The Ethics Council is currently studying that issue and may release a report in the future.

The house also adopted a Board of Trustees report that reaffirmed the organization's opposition to therapeutic substitution "in any patient care setting."

The report addressed issues relating to pharmacy benefit managers (PBMs) and the use of formularies by managed care companies. It called on the AMA to work with the Pharmaceutical Care Management Association to get PBMs to incorporate AMA policies on formulary standards, ethics in managed care costcontainment of prescription drugs, and drug utilization review principles into PBM formulary management. Those principles include physician oversight of formularies and acceptance that costs must be secondary to safety and efficacy in the selection of drugs for formularies.

The report called on the Food & Drug Administration and Federal Trade Commission to continue to monitor the relationships between manufacturers and PBMs, especially with regard to manufacturers' influence on PBM formularies and drug-switching programs, and to take enforcement actions as appropriate.

It urged physicians to report to the FDA MedWatch reporting program any instances of adverse consequences"including therapeutic failures and adverse drug reactions"-that have resulted from the switching of therapeutic alternates.

In another action, the house adopted a policy calling for the return of unused medications to pharmacies from longterm care facilities (LTCFs), if certain conditions are met.

The policy is similar to that adopted by the American Society of Consultant Pharmacists. It calls for return of the drugs for credit if the drug is not a controlled substance; is dispensed in tamperevident packaging; and is returned intact; and, in the professional judgment of the R. …