Prescription for Change: Over-the-counter sales of medical records

Adriane Fugh-Berman, M.D.
May / June 2007

In all likelihood, every time you fill a prescription, information about you is sold to a company that then resells that information to pharmaceutical companies for promotional purposes. Pharmaceutical companies may know that you used Seasonale for six months last year, then switched to a generic birth control pill; that you took the antibiotic Zithromax in September and Ketec in December; that you use a nasal steroid during the spring pollen season every year; and that you filled one prescription for Prozac last month but haven’t picked up a refill. Feeling invaded yet? Your name is removed from your medication history, which is supposed to make it all better. Industry may know all your intimate health details, but as long as they know you as number 0178 rather than by your name, it’s all legal.

“Prescription tracking” is the system by which pharmaceutical companies determine the success or failure of all promotional efforts. IMS Health, the largest information distribution (or data-mining) company, obtains records on more than two thirds of prescriptions filled in community pharmacies. Other information distribution companies include Dendrite, Verispan, and Wolters Klower.

In many cases, drugs used by a patient reveal his or her diagnosis. Insulin, for example, is only used by diabetics; protease inhibitors are only used by HIV-positive patients; and antihypertensives are primarily used by people with high blood pressure. In other cases, drugs may be used for multiple purposes. Some medications, for example, are used for both seizures and migraines. Antibiotics, of course, are used for infection, but generally one can’t tell which infection someone has by the antibiotic being taken. So information purchased from pharmacies may be supplemented with information purchased from insurers to pinpoint individual patients’ diagnoses.

Gathering prescription information on specific patients is a recent marketing development that is being used to refine information on physicians’ prescribing preferences. The identity of individual patients is of little importance to pharmaceutical companies. What they are really after is information about a specific physician’s prescription-writing habits.

Physicians’ names are not protected by privacy laws in the way that patient names are protected — and data-mining companies have long gathered information on the number of prescriptions a particular doctor writes for specific drugs. Although pharmacies keep data on physicians that are identified only by the physician’s number, these numbers are easily matched to physician names by comparing them with lists of names purchased from the American Medical Association (AMA) Physician’s Masterfile. The Physicians’ Masterfile is a database that contains demographic information on all U.S. physicians, whether or not they are members of the AMA. Licensing information from the Physician’s Masterfile, and other database product sales, netted more than $44 million for the AMA in 2005.

Physicians control the distribution of prescription drugs, so every bit of information on them is valuable to the pharmaceutical industry. (Although physician assistants and nurse practitioners prescribe as well, both of these groups tend to prescribe more rationally than physicians. Because physician assistants and nurse practitioners do not prescribe large amounts of expensive branded drugs, their prescribing habits are not usually tracked. That may change in the future). The industry uses this prescribing data to maximize the efficiency of “detailing”, their term for the promotion of drugs to doctors by pharmaceutical sales representatives (otherwise known as drug reps).

Prescribing data are used to rank physicians on a scale from one to ten based on how many prescriptions they write. Drug reps also use prescribing data to track how many of a physician’s patients receive specific drugs, how many prescriptions the physician writes for targeted and competing drugs, and how a physician’s prescriptions change over time. All this information helps drug reps tailor their marketing messages to the physicians.

New Hampshire was the first state to ban the sale of prescription data; it was promptly sued by IMS and Verispan. Other states considering similar bills include New York, Nevada, Arizona, Illinois, Kansas, Maine, Massachusetts, Rhode Island, Vermont, Washington, West Virginia and Texas. Data-mining companies argue that prescription data is used for public health purposes, but the use of these data by government and academic researchers is vanishingly small. Make no mistake about it: the purpose of prescribing data is to assist industry to influence physicians to prescribe the most expensive drugs.

What can you do about this? Support legislation banning the sale of prescribing data and medical histories, and encourage your state legislators to introduce such legislation if they haven’t already. In the meantime, ask your pharmacy – and your insurance company – whether they sell prescribing or medical history data. Most chain pharmacies do, while independent pharmacies are less likely to sell these data. If your pharmacy or your insurance company sells your data, let them know you don’t appreciate it and that (if there is a pharmacy or insurer in your area that doesn’t sell your information) you’ll be switching your business. Using pharmacies and insurance companies that opt out of the data mining system is a good way to support companies that protect your privacy, and to alert these businesses that selling your medical history, even with your real name removed, for pharmaceutical companies to use for drug promotion is not acceptable.