In hopes of reducing inappropriate opioid prescribing, the Chicago City Council on Wednesday passed an ordinance that requires all pharmaceutical sales reps to become licensed.
The ordinance, which the pharmaceutical industry opposed, will require sales reps to undergo training for ethics, marketing regulations, and applicable laws. Reps will also have to file reports with the city that disclose the names of doctors they visit as part of their work, the number of visits, and any samples, materials, or gifts provided, along with their value. Reps will also have to pay a $750 licensing fee and renew the licenses annually.
“Opioid addiction is a public health issue impacting cities like ours across the country,” said Dr. Julie Morita, the Chicago Department of Public Health commissioner, in a statement when the ordinance was unveiled last month. “Law enforcement alone cannot solve the problem.” (The ordinance can be found on page 95).
The move is the latest effort by the city to combat an epidemic of deaths and overdoses attributed to opioid painkillers. Every day, more than 40 Americans die from overdoses of opioid painkillers, according to federal health officials. And each year, 2 million people abuse or misuse the drugs.
Chicago is one of a handful of local or state governments around the country to have filed lawsuits against several drug makers, accusing them of deliberately downplaying the risks of their painkillers and improperly encouraging physician prescribing, which caused some patients to become addicts.
As a result, the city said it paid for some prescriptions unnecessarily and has previously noted that its health insurance plan has reimbursed claims for approximately $12.3 million for opioids between 2008 and 2015. The city sued Purdue Pharma, Endo International, Teva Pharmaceuticals, Actavis (which is now Allergan), and Johnson & Johnson’s Janssen unit. Pfizer reached a deal to avoid the lawsuit.
The city expects to collect more than $1 million in licensing revenue and will use that to support ongoing efforts to educate doctors and the public about opioids, and cover the cost of regulation, according to a spokeswoman for the Office of Budget and Management.
Chicago officials also hope to use the funds to boost existing investments in drug treatment, expand opioid and heroin addiction treatment, and provide seed funding to existing health clinics to expand and create new opioid treatment programs, she added.
Once the ordinance goes into effect next July, Chicago will become only the second government in the country to take such a move in order to license sales reps in hopes of clamping down on inappropriate marketing and prescribing. In 2008, Washington, D.C., began requiring sales reps to become licensed. A license costs $175.
Not surprisingly, the pharmaceutical industry fought the Chicago ordinance. The Pharmaceutical Research and Manufacturers of America, the industry trade group, cosigned a letter to the city council criticizing the effort and argued that it will not address the opioid epidemic.
A spokeswoman for the group sent us a note reiterating this point. “Instead, we should engage in a constructive dialogue about promoting public education and sound policies to prevent and curb opioid abuse,” she wrote, adding the Affordable Care Act already requires drug makers to report payments to physicians.
One expert suggested the ordinance may be helpful, but may also have some limitations.
“If they collect all that information, the city could use that as leverage on the pharmaceutical companies,” said John Mack, who publishes Pharma Marketing News. “The data they’re collecting could make a better case for the argument that doctors overprescribe these medications.”
However, he also noted that sales reps are following marching orders and, despite any required education or training, will remain under pressure to market certain medicines at certain times.
“I think will be hard to prove its an effective way to control the prescribing, so I don’t think it’s really going to solve the problem directly. It might help indirectly if the city can say that overprescribing is caused by aggressive sales tactics,” he continued. “I’m not sure how they can manipulate the data to prove anything. But they may be able to squeeze something out of the data. They’re asking for a lot.”