After a nine-month investigation into direct-to-consumer telehealth platforms launched by Eli Lilly and Pfizer, a group of senators has released a report suggesting the platforms may allow pharmas to inappropriately influence doctors’ prescribing habits.
The lawmakers—Democratic Sens. Dick Durbin of Illinois, Peter Welch of Vermont and Elizabeth Warren of Massachusetts and Independent Sen. Bernie Sanders of Vermont—began their probe in October.
They sent letters to both Lilly and Pfizer complete with a list of questions aimed at uncovering whether LillyDirect and PfizerForAll, respectively, “steer patients toward particular medications and [create] the potential for inappropriate prescribing that can increase spending for federal health care programs.”
In March of this year, the senators expanded the probe to include several of the platforms’ contracted telehealth partners, sending five companies similar lists of questions about their relationships with the drugmakers.
Both Lilly and Pfizer have maintained that their platforms do not incentivize doctors in any way to prescribe the companies’ own medications. The senators, however, still aren’t quite sure.
They released a report (PDF) Thursday summing up the findings of their investigation, titled “Big Pharma’s New Sales Scheme: Expanding Patient Access or a Virtual Pill Mill?”
In an accompanying statement, Warren said, “Big Pharma continues to use shady tactics to squeeze patients and line its own pockets. While we’re working to lower costs for families, these giant companies seem to be propping up new telehealth platforms just to push their own drugs on patients who might not even need them. We need to hold Big Pharma accountable and stop this abuse of power.”
The lawmakers have suggested since the start of their investigation that the concept of accessing care through a branded pharma website could lead patients to believe that they’ll be able to receive a specific Lilly or Pfizer drug “with just a few clicks,” an argument reiterated in the report.
According to the investigation, patients routed to a tele-provider visit via the platforms were given a prescription 85% of the time through PfizerForAll and 74% of the time through LillyDirect. In one example, more than 500 of the 620 LillyDirect patients who had a virtual visit via telehealth partner 9amHealth were prescribed a medication, a rate of around 83%, compared to just 39% of 9amHealth’s overall patient population.
LillyDirect users who saw a doctor contracted by 9amHealth were six times more likely to be prescribed a Lilly product than another brand-name med, while two-thirds of all prescriptions from doctors linked to another partner, Form Health, were for Lilly drugs, according to the report.
Though the report acknowledged that neither Pfizer nor Lilly offers any “overt” incentives to doctors who prescribe their brand-name drugs, the senators asserted that the companies do still “want individual telehealth prescribers working under these contracts to write prescriptions for Eli Lilly and Pfizer medications” and so could potentially use information from the DTC platforms to “unleash their sales representatives” on certain doctors.
Some of the telehealth companies reportedly share clinician names with their pharma partners—or have them clearly listed online—and some also let clinicians know when a patient has been routed to them via LillyDirect or PfizerForAll, the probe found.
Using data from the federal Open Payments database, the investigation identified at least a handful of providers who work for Lilly’s telehealth partners and have received several dozen payments combined from the Big Pharma. Though the report didn’t specify those providers’ rates of prescribing Lilly-branded drugs, it noted that “studies repeatedly have shown that pharmaceutical industry payments to doctors are associated with increased prescribing of that company’s products.”
The senators also observed a possible link between doctors who have received payments from Lilly and those who show up on LillyDirect’s online tool for finding nearby in-person care. When they used the tool—facilitated by HealthGrades—to search for obesity care near the U.S. Capitol, they said, four of the six closest doctors had received payments from Eli Lilly. Meanwhile, when they performed a similar search through HealthGrades itself, none of the 10 providers listed by LillyDirect appeared to be included in the top 500 results.
“This suggests that Eli Lilly is filtering or adjusting the search terms ... to yield certain providers in this search on its own platform, including those—by Lilly’s own admission on its website—who may ‘also conduct work for Lilly,’” the senators wrote.
Along with the telehealth appointments’ outcomes, the senators also took issue with how many of the virtual visits were performed. For one, they noted, appointments don’t always require video, “meaning providers may be prescribing Pfizer and Eli Lilly drugs without laying eyes on a patient." In another concern, the senators said most virtual visits require only a patient questionnaire rather than full medical records.
At least two telehealth services, the LillyDirect-contracted Cove and former Pfizer partner Populus, let patients preselect the drug they want to be prescribed before even meeting with a provider, the senators pointed out.
The report suggested those findings may put providers at risk of becoming entangled in a kickback scheme. It noted that the Department of Health and Human Services’ Office of the Inspector General has previously identified limited patient interactions, limited access to patients’ medical records and “a directive to prescribe a preselected item, regardless of clinical appropriateness” all as “fraudulent aspects” of such schemes.
The senators didn’t share what their next steps might entail but implied in individual statements that they’ll be seeking to rein in the drugmakers’ possible sway over both doctors and patients.
“Big Pharma’s newest sales scheme funnels patients to telehealth companies chosen and paid by the drug companies, seeking to influence prescription pads,” Durbin said. “Our findings shine a light on potential conflicts of interest and inappropriate prescribing that can balloon health care spending and lead to inferior care for patients. With these revelations, we must crack down on Big Pharma’s latest ploy to promote and sell expensive medications at the expense of patients and taxpayers.”