Free Pharma Meals: NPs, PAs Will Get the Same Scrutiny as Docs

James F. Sweeney


July 01, 2019

The way Paul Ehrmann, DO, sees it, if he doesn't accept free lunches or gifts from pharmaceutical salespeople, neither should his physician assistant (PA).

Ehrmann, a family practitioner in Royal Oak, Michigan, has a general policy against accepting anything of value from pharmaceutical companies, such as event tickets, trips, dinners, or honoraria. He has instructed the part-time PA in his practice to do the same. "I think you should try to be consistent and have everyone follow the same rules," he says.

By contrast, Marc Price, DO, a family physician in Malta, New York, doesn't know whether his PA is having meals paid for by pharma reps and he doesn't care. "She's an adult. I'm not going to tell her what to do," Price said.

The question of whether nurse practitioners (NPs), PAs, and other nonphysician clinicians should accept gifts from pharmaceutical companies and medical device makers has been raised again by a new law that will soon make such gifts public.

Currently, the Physician Payment Sunshine Act requires drug and medical device manufacturers to report any gifts to physicians. The data are compiled and searchable in the CMS Open Payments database. However, NPs, PAs, and other clinicians in the same practice can receive benefits without it being disclosed.

That will change in 2021, when manufacturers must begin reporting gifts to those clinicians, as well. The data will be publicly available in 2022.

Why the Law Is Changing

The Sunshine Act went into effect in 2013 in order to increase transparency around the financial relationships among physicians; teaching hospitals; and the manufacturers of drugs, medical devices, and biologics.

The decision to expand reporting requirements to include PAs, NPs, clinical nurse specialists, certified nurse anesthetists, and certified nurse-midwives was made for several reasons.

For one thing, their numbers are increasing, and they're playing a bigger role in healthcare. There are more than 270,000 NPs practicing in the United States, and they handle more than 1 billion patient visits annually, according to the American Association of Nurse Practitioners (AANP).[1] And there are more than 115,000 certified PAs, according to the American Academy of Physician Assistants (AAPA).[2] The shortage of primary care physicians means that NPs and PAs are taking on more duties than ever before.

Also, NPs can now prescribe drugs, including controlled substances, in all 50 states. PAs prescribe as well, though they face restrictions in some states.

In addition, the number of physicians willing to meet with sales reps is declining. According to a report from ZS Associates, a sales and marketing solutions firm in the pharmaceutical and healthcare industry, only 46% of physicians are considered accessible to pharma reps.[3]

A growing number of doctors work for healthcare systems that restrict contact, whereas some physicians avoid meetings because they do not want it reported or simply because they're too busy. Those restrictions generally don't apply to NPs and PAs.


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