1. Jennifer L. Reck, Prescription Policy Choices A Tri-State Academic Detailing Collaborative 2008 Int’l Symposium on Pharmaceuticals In the Home and Environment, S. Portland, Maine, November 11, 2008

2. Prescription Policy Choices Nonprofit, nonpartisan 501(c)(3) educational and public policy organization focused on prescription drug policy Evaluate policies and programs that effectively reduce prescription drug prices, increase access to medications, minimize conflicts of interest & promote evidence- based prescribing

3. What is Academic Detailing? Also known as prescriber education and outreach Practice of sending independent, trained clinicians to prescribers’ practices in order to present objective, comparative, evidence- based information on prescription drugs

4. Academic Detailing in Context Avorn coined the term in the early 80s & did initial RCTs establishing its efficacy for better aligning prescribing practices with the scientific evidence The US spends more per capita on prescription drugs than any other country - $216.7 billion in 2006 – yet many patients still lack access & the US ranks poorly in health outcomes

5. Academic Detailing in Context The industry spent $12 billion in 2006 on marketing Employs approximately 90,000 pharmaceutical sales representatives, or approximately 1 for every 5 doctors Conflict of interest concerns

6. Academic Detailing Legislation in Northern New England ME passed legislation funding academic detailing in 2007 VT expanded funding for its program in 2007 NH passed legislation supporting academic detailing in May of 2008

7. Northern New England Academic Detailing Planning Initiative Prescription Policy Choices convened stakeholders in ME, NH and VT for an academic detailing planning initiative in the spring of 2008 Informational summit to identify best practices from existing programs Working groups to identify potential points for collaboration to maximize impact

8. Academic Detailing Planning Initiative Funders Nathan Cummings Foundation Consumers Union Endowment for Health Maine Health Access Foundation The Bingham Program Community Catalyst / The Prescription Project

9. Academic Detailing Informational Summit US: – Pennsylvania (since 2005, administered by Harvard’s Independent Drug Information Service, www.RxFacts.org) – Vermont (since 1999) – South Carolina (since 2007, Medicaid / mental health focused) Worldwide: Australia, Canada

10. Cost-savings Though quality-focused, academic detailing has demonstrated an ability to cut costs Overall cost savings as high as $2 for every $1 invested in prescriber education programs demonstrated in: – RCTs (Soumerai & Avorn, NEJM, 1986) – Real-world practice (Australia’s program over the past 10 years)

11. Northern New England Academic Detailing Planning Initiative Potential points for collaboration: – identifying clinical topics for focus – conducting literature reviews – developing key messages and physician and patient educational materials – training academic detailers

12. Northern New England Academic Detailing Planning Initiative Funding models: – Manufacturer fees (ME, VT) – pharmaceutical sales representative licensing fees (WDC) – Pharmaceutical industry settlements (Zyprexa) – Medicaid matching funds

13. Northern New England Academic Detailing Planning Initiative Executive summary and full report available at: www.policychoices.orgwww.policychoices.org A Template for Establishing and Administering Prescriber Support and Education Programs: A Collaborative, Service-based Approach for Achieving Maximum Impact

14. Part of a Growing National Movement Bills also passed in 2008 in: – New York, Massachusetts &Washington, DC State legislation expected in 2009: – Colorado, Maryland, Wisconsin & Washington Federal legislation: Independent Drug Education Act of 2008 (IDEA) – Would provide federal grants for educational material development and outreach programs

15. Upcoming Educational Session on Academic Detailing The NHMS, in conjunction with MMA and PPC, is presenting a CME program entitled “Academic Detailing: Advancing Evidence- Based Prescribing Practices” – Keynotes: Dr. Marcia Angell & Dr. Jerry Avorn – November 17, 9:00 am-12:00 pm – Concord, New Hampshire Register with tduffany@policychoices.org

16. For Further Information on Academic Detailing Please feel free to contact me at: jreck@policychoices.org