New incentive program rules don't solve ethical dilemmas

Drug Store News, Oct 9, 1995 by Ken Rankin

To some pharmacy leaders, medication incentive programs represent a clear opportunity for pharmacists to secure their economic future and nail down a key position in the starting lineup of the health care team.

To others, these "switch" programs are a minefield of ethical, moral and legal problems for the profession. At the very best, they are a calculated attempt by commercial interests to induce pharmacists to engage in practices that they otherwise would not engage in. At worst, they represent outright bribes that enrich pharmacists at the expense of the public.

To be sure, many of these incentive programs reward pharmacists for taking actions that may benefit patients through improved therapy or reduced costs. But that's not their purpose.

They are designed to help drug manufacturers build market share and/or enable managed care networks to reduce their operating costs. If they also help patients, that's fine - but it's not essential.

To help pharmacists pick their way through the ethical briar patch posed by these switch programs, the American Pharmaceutical Association released a new set of guidelines for participation in sponsored medication incentive programs.

Among other things, the new APhA guides stress that such programs must protect the privacy rights of patients, and that both patients and pharmacists are entitled to full disclosure of all material facts before being asked to participate.

No ethical guidelines

But APhA's guidelines fall short when it comes to offering pharmacists advice on whether participation in any particular switch program is ethically kosher.

Although APhA says "the inherent program design must not cause any harm to the patient," the guides contain no requirement that these incentives result in any benefit whatsoever to the patient.

As long as the program rewards the pharmacist, it need offer no economic or therapeutic benefits to consumers in order to be ethically "acceptable" under APhA's new standard.

Pharmacists who follow these tissue-paper ethical standards should not expect to be immunized from criticism for participating in incentive programs that are ultimately declared to be abusive.

That's clear enough from the following disclaimer tacked on to the end of the guidelines: "APhA does not assume any responsibility for the legality or propriety of any specific medication incentive programs that may be adopted which conform to the precepts of these guidelines."