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Amid intense criticism, lawmakers have removed a controversial provision in the 21st Century Cures Act that would have exempted companies from reporting payments made to doctors for receiving continuing medical education sessions, medical journals, or textbooks.

The provision “is not going to be in the bill when it gets to the House floor” on Wednesday for a vote, a spokeswoman for Representative Diana DeGette, a Democrat from Colorado, wrote us. The change came one day after Senator Chuck Grassley (R-Iowa) threatened to put a hold on the entire bill unless the language was removed. We asked the House Energy and Commerce Committee for comment and will pass along any reply.

The exemption — which was widely supported by drug and device makers, as well as physicians — was an attempt to roll back requirements for reporting such payments to a federal database that tracks financial relationships between companies and physicians.


Known as OpenPayments, the database was launched in 2014 in response to concerns that financial ties between drug and device makers and doctors may unduly influence medical practice and research. It was included in the Sunshine Act provision in the Affordable Care Act. As we noted previously, an analysis earlier this year found that payments can affect prescription rates.

However, amid complaints from industry and physician groups, the Centers for Medicare and Medicaid Services has, more than once, revised language that would have created an exemption for reporting the value of continuing medical education, or CME, and medical information handouts. In late 2014, however, CMS officially omitted the language and, ever since, Republican lawmakers have made it a goal to formally create an exemption.


Groups that represent physicians and pharmaceutical marketers argue the reporting requirement would stifle access to important information and have a detrimental effect on CME programming. CME payments are made by manufacturers or group purchasing organizations to CME providers, which are either commercial firms or nonprofits that organize courses for physicians.

As we noted previously, more than 100 national and state medical societies last June backed a Senate bill to create an exemption. The groups complained about “onerous and burdensome reporting obligations … that have already chilled the dissemination of medical textbooks and peer-reviewed medical reprints and journals.” They sought to avoid “a similar negative impact” on CME sessions.

But CME has been controversial, with accusations that drug and device makers not only fund the courses, but may also control the educational curriculum. Last year, industry support for CME totaled $693 million, a 2 percent rise, from the previous year, according to the most recent report from the Accreditation Council for Continuing Medical Education, which regulates CME activities.

Critics have complained that CME and expensive textbooks can influence doctors to prescribe expensive brand name drugs. As they see it, transparency is undermined if drug and device companies are allowed to avoid reporting the value of such sessions and handouts.

  • I run Medical Affairs for a medium sized Pharma Company. I am also a practicing physician and have been in academia for many years. This article and many others like it fail to point out 2 important points about pharma sponsorship of CME: 1) Companies have no say, control, influence or role in choosing the people who present the CME topics; 2) The CME providers clearly disclose to the viewing public what companies, if any, sponsored the CME. Asking companies to try to figure out which faculty members get paid and what they are getting paid for (i.e.; reimbursement for travel, versus honoraria, etc) from the unrestricted money given to a CME provider is not only extraordinarily burdensome, but falsely implies the presence of relationships that do not in fact exist. It is misleading and ultimately will lead many great teachers to eschew participation for fear of being labeled ‘in the pocket’ of pharma. We have to stop the madness.

  • At the same time, Grassley does not turn down campaign contributions from Pharma. According to Grassley most recently took in $151,550 from Pharma, making him the 10th highest ranking senator in terms of campaign dollars from that source.

    • Looks like pharma was the 10th largest contributor to Grassley, based on rankings by industry or professional sector, actually. In any event, not many Republicans have consistently explored issues that have put the pharma industry on the hot seat, either.

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