Social Policy in Ontario

Ontario is banning a new Big Pharma marketing scheme that uses electronic medical records to sell drugs.

The prohibition comes after a Star investigation found Telus Health has been inserting electronic vouchers for brand name drugs into its popular medical record software (EMR) used by thousands of doctors across Canada.

“Ontario patients must have confidence that (prescribing) decisions are not influenced by marketing programs or electronic vouchers,” Health Minister Dr. Eric Hoskins said in a statement.

“This practice is particularly concerning given its powerful influence on the brands of drugs that Ontarians receive, often without patients even being aware that this practice is happening.”

The electronic vouchers steer patients to brand name drugs over their less expensive generic equivalents, and have raised concerns that patients’ health records are being used to sell pricier drugs that can pile unnecessary costs onto private insurance plans.

The voucher feature, found in medical record software owned by Telus Health and other companies, will be disabled over the coming weeks, said Hoskins.

The minister said he is working on the prohibition in collaboration with OntarioMD, which oversees and certifies electronic medical record software.

A Telus Health spokesperson said the company “has always been careful to ensure that our EMRs comply with provincial policy as it evolves over time.

“The minister’s directive to the industry is clear, and we are taking the necessary steps to implement the required changes.”

The Star had found that brand name drug companies paid Telus to digitally insert the vouchers so that the prescription is filled with their product instead of the lower-cost generic competitor that pharmacists normally reach for.

The voucher works like a coupon: If a patient’s insurance does not cover the full cost of the pricier brand name drug, the drug’s manufacturer will cover part or all of the cost difference from its generic equivalent.

Doctors had to agree to the voucher feature in the Telus software before it was enabled on their systems, and physicians could opt out at any time.

The Star found in some cases, doctors were unaware they had inadvertently enabled the feature.

Thousands of doctors across Canada use electronic medical records to take notes during patient visits and to create a prescription to be filled by the patient’s pharmacy. Telus Health, a subsidiary of the telecom giant, is a dominant player in the electronic medical records field.

Hamilton Dr. Monica De Benedetti applauded the minister’s “strong and important” decision to prohibit electronic vouchers.

“Patient information should not be used for marketing purposes — patients aren’t ways to make money, they’re people we care for and try to keep healthy,” said De Benedetti, lead physician for the Hamilton Family Health team, a network of 165 physicians.

She said some of the team’s doctors were unaware the vouchers had been added to their medical record system following a 2016 software update —nor were they aware that information about those vouchers was being shared with drug companies.

Without the physicians being fully aware, they could not tell their patients about the program, De Benedetti said.

The health team encouraged its members to turn off the voucher feature, and De Benedetti and others raised their concerns with Telus and OntarioMD, a subsidiary of the Ontario Medical Association that oversees the certification of electronic medical record software.

“I’m very glad to hear this issue has been pushed forward not just for our patients but for all patients in Ontario,” she said.

Telus said drug manufacturers paying to have their vouchers in the EMR receive “aggregated and anonymized, province-level statistics” on the total number of vouchers printed off for their products, Telus said.

No patient or physician information is shared, the company said.

Paul Lepage, president of Telus Health, previously said, “Protecting our customers’ privacy and safeguarding data is, and will always be, a cornerstone of our business.”

Telus Health said the voucher feature has been positively received by the majority of doctors using the software. The voucher is offered only after a physician chooses a drug by its brand name to prescribe “so there is no influence on what drug the physician selects,” a company spokesperson said.

Meanwhile, the brand companies said the payment assistance vouchers are about giving the patient choice between brand and generic drugs without having to spend more money.

Critics, however, say vouchers manipulate physicians’ prescribing practices, adding that many doctors use a drug’s brand name when writing a prescription out of habit and aren’t necessarily instructing that a drug be dispensed over its generic.

The vouchers also reinforce a false premise that generics are inferior in quality to the original brand name drugs, say doctors critical of the feature.

Generics contain the same pharmaceutical ingredients and can cost as little as one-fifth of the brand price.

To keep costs down, many drug plans encourage pharmacists to substitute a cheaper generic drug when filling a prescription for a brand drug, unless the prescribing doctor specifically requests otherwise. Without a voucher, even if a doctor uses the brand name on a prescription, pharmacists may substitute the cheaper generic.

The voucher feature is offered in a number of electronic medical record systems, a Telus spokesperson said, adding that its software, which introduced vouchers in August 2016, follows ethical principles not necessarily present in other software.

Telus has been a significant beneficiary of a provincial government-funded program that saw more than $340 million distributed to doctors to adopt electronic medical records in their practices. Roughly half of the doctors who received funding went with a Telus-owned EMR that now includes the voucher feature.

At St. Michael’s Hospital in Toronto, about 100 physicians and nurse practitioners in the family medicine unit use a Telus EMR to write prescriptions for their patients. All of them have opted out of the voucher feature.

One of those doctors, Nav Persaud, said, “It’s good that this function has been banned because it wasn’t actually helping people. It was an invasive and inappropriate marketing tool.”

https://www.thestar.com/news/queenspark/2017/09/14/big-pharma-marketing-scheme-banned-by-ontario.html