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Harrison 11-20-2007 05:09 PM

You'll like this one. And the ending paragraph is a kicker too...for you BCBS fans.

Drug Switches May Lead To Doctor Punishments

For the first time, the American Medical Association is warning that doctors who switch their patients off brand name drugs, including Lipitor, and onto generics could face criminal and civil punishment.

NewsCenter 5's Janet Wu reported that the warning from the AMA comes after numerous inquires from physicians nationwide. The AMA's answer could not be more clear. A physician accepting payment from an insurer in exchange for moving a patient from a brand name to a generic drug could potentially face both criminal and civil liability exposure under the federal anti-kickback statute. The penalties are as much as five years in prison, with criminal fines as high as $25,000 for each violation, civil penalties up to $50,000 and exclusion from federal programs, such as Medicare in the future.

Rep. Peter Koutoujian said as Chairman of Health Care and as a patient on cholesterol medication, he wants tougher state laws governing doctors getting financial benefits for switching their patients' medications.

"We want to know that the decision is being made in our best interest. And if there are incentives being offered to the doctor, while that decision might be in our interest, how can we truly trust that decision?" Koutoujian said.

While the practice earlier this year in Michigan of doctors receiving $100 from Blue Cross for each patient they switched off Lipitor to a generic drug has never been practiced in Massachusetts, doctors in the Bay State who switch enough patients off brand names receive a financial reward at the end of the fiscal year.

Dr. Jerome Kassirer, former editor of the New England Medical Journal, has written extensively on the relationship between doctors and big business.

"Doctors, since the passage of Medicare, have become accustomed to getting a fee for everything they do," he said. "Doctors seem to believe that they are entitled to all this largesse from industry."

But despite the AMA warning, Dr. Thomas Lee, CEO of Partners Community HealthCare, continues to defend the practice by doctors because it also saves patients money. "We support the use of pay-for-performance contracts that reward providers for improving quality and efficiency. We think this approach is far better than simply shifting more costs onto consumers," Lee said in a statement.

The AMA said that any physician's first priority must be the patient's health and the best medical practices available to treat it. It said it was not aware of any doctors being prosecuted under the federal anti-kickback statute for switching patients off brand names.

Meanwhile, it was revealed last week that Blue Cross Chief Executive William Van Fassen was rewarded with more than $16 million in retirement pay even though he did not leave the company. He remains chairman of Blue Cross/Blue Shield.

Terry 11-20-2007 05:36 PM

Unacceptable for the doctor to get a little money but the bastards who make a living from denying care get a 16 million dollar kickback. Lovely. From the doctor all the way down reeks of a lack of ethics and lapses in ethically sound practices are the bane of America today.

But Michigan.....For Shame! Oh well...We are the proud owners of Dr. Jack Kevorkian. Touchette .

Terry Newton

Harrison 12-11-2007 06:58 PM

Just a follow-up story from a Boston TV station...

Penalties Posed For Rewarding Docs For Drug Switches

2 hours, 22 minutes ago

Penalties may be lodged against doctors who change prescriptions from brand-name drugs to generics without a patient's permission.

"We can't allow any system to exist that intrudes upon the sanctity of the doctor patient relationship," Rep. Peter Koutoujian said.

NewsCenter 5's Janet Wu reported that the public health chairman said the bill he plans to file Wednesday will make it illegal for any insurance carrier to financially reward physicians for switching the prescriptions or medical products of any patient.

In August, Team 5 Investigates first reported that Blue Cross of Michigan was paying doctors to substitute Lipitor with a generic of Zocor. Team 5 Investigates also uncovered a routine practice in Massachusetts where physicians receive financial reimbursements if they switch enough patients off brand name drugs.

Genie Holland, who had been on Lipitor for four years, was among those switched without her consent.

"I know now it was not a good decision, but I didn't make the decision -- the doctor did," Holland said.

"I've filed legislation based upon this NewsCenter 5 investigation," Koutoujian said.

Koutoujian said saving the insurance company or the patient money couldn't be the primary motive for switching medication.

"This may or may not be good for the patient, but with an incentive involved, we'll never know what the motivation was for this decision," Koutoujian said.

Holland said after several months on the generic, her cholesterol scores skyrocketed. The doctor increased the dosage, and Holland lost 25 pounds, but her cholesterol level is still too high. She said that she hopes the bill is passed into law.

"I'd like them to make it based on what works for me as the patient, rather than anything else," Holland said.

"If there are incentives or disincentives that are changing the agreements made between a doctor and a patient that are not good for the patient, than there's something wrong with that system," Koutoujian said.

Koutoujian said his bill would set a maximum fine of $10,000 for insurance carriers and doctors violating the ban. Meanwhile, Holland said she'll ask her doctor about switching back to Lipitor since it will only cost her an additional $5 per month. Unlike Holland, many patients switched off Lipitor have had no problems, and it has saved them a lot of money. But Koutoujian said medical efficacy -- not money -- should be the deciding factor.

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