Durbin, Warren, Welch, Sanders Demand Answers From Telehealth Companies Regarding Their Financial Relationship With Pfizer, Eli Lilly Amid Concerns Of Inappropriate Prescribing
WASHINGTON – U.S. Senate Democratic Whip Dick Durbin (D-IL) sent letters to five telehealth companies that have held contracts with Pfizer and Eli Lilly, inquiring about their financial relationships and possible influence on prescriptions for medications from those two pharmaceutical manufacturers. These new arrangements can use direct-to-consumer (DTC) advertisements that steer patients toward particular medications and create the potential for inappropriate prescribing that can increase spending for federal health care programs. Along with Durbin, the letters were also signed by U.S. Senators Peter Welch (D-VT), Elizabeth Warren (D-MA), and Bernie Sanders (I-VT). The letters are addressed to the CEOs of 9amHealth, Thirty Madison (Cove), Form Health, Populus Health Technologies, and UpScriptHealth.
“Through a partnership with [the telehealth company], Eli Lilly/Pfizer has launched a new telehealth platform that links patients interested in receiving its medications with a health care provider who can virtually prescribe those pharmaceuticals. This manufacturer-sponsored arrangement appears intended to steer patients toward particular medications and creates the potential forinappropriate prescribing that can increase spending for federal health care programs. We write to learn more about the financial relationship between Eli Lilly/Pfizer and [the telehealth company] given the potential implications for the federal Anti-Kickback Statute (AKS),” the Senators wrote in their letters.
Federal law, specifically the Anti-Kickback Statute, prohibits the willful payment of remuneration to induce patient referrals for Medicare or Medicaid-covered services or goods. In the letter, the Senators requested information by April 15 about the financial nature of the telehealth companies’ contracts with Pfizer and Eli Lily.
The United States is one of only two countries in the world that permit DTC advertising of prescription drugs, in part because this practice has been shown to increase patient demand for advertised drugs and the likelihood of a patient receiving a prescription for that drug. Pharmaceutical companies, including Pfizer and Eli Lilly, spend an estimated $6 billion annually on DTC advertising to boost patient demand for medications. As a result, a small number of prescription drugs advertised on television accounted for 58 percent of Medicare’s overall spending on prescription drugs between 2016 and 2018.
“Telehealth can help to address barriers to care, including by expanding access for patients facing transportation barriers, helping to overcome stigma, and identifying providers when there may be workforce shortages. But those important aspects of care can be undermined without comprehensive services that ensure a thorough patient evaluation and follow-up, especially if there is any appearance of a conflict of interest for the treatment provider,” the Senators continued.
The U.S. Department of Health and Human Services’ Office of the Inspector General (HHS OIG) has been wary of telehealth platforms, issuing a Special Fraud Alert in 2022 to warn health care practitioners of specific risks of schemes involving telehealth platforms that “intentionally paid physicians … kickbacks to generate … prescriptions for medically unnecessary … medications, resulting in submission of fraudulent claims to Medicare [and] Medicaid.” HHS OIG listed limited interaction with the purported patient, limited opportunity to review the patient’s medical records, and/or a directive to prescribe a preselected item, regardless of clinical appropriateness as potential fraudulent aspects of telehealth platforms’ arrangements with prescribers. In the letters, the Senators state that the telehealth companies’ platform appears to reflect many aspects of the HHS OIG warning for potential fraud.
The letters to the five telehealth companies cite statements or aspects of the telehealth arrangement that raise concerns about inappropriate prescribing, including a job posting by UpScriptHealth advertising that “on average, providers can complete 6-10 visits an hour,” and defining “a completed visit is either an approval or denial of prescription request.” For Cove, the Senators note that the patient appears to first purchase a treatment plan prior to beginning the consultation with a medical provider, creating the impression that the health care professional is merely being used for their prescription pad, rather than a thorough patient evaluation and intervention.
Today’s letters come after Durbin, Warren, Welch, and Sanders sent a letter to the CEOs of Pfizer and Eli Lilly in October demanding answers about the pharmaceutical companies’ recent move to establish new DTC telehealth platforms.
The letters are Durbin’s latest action in cracking down on excessive prescription drug advertising that can harm patients and increase prescription drug costs. Last November, Durbin took to the Senate floor to request unanimous consent for his bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce excessive spending on medications. Last month, Durbin introduced the Protecting Patients from Deceptive Drug Ads Act, bipartisan legislation that would protect public health and close regulatory loopholes by having the Food and Drug Administration (FDA) address false and misleading prescription drug promotions by social media influencers and telehealth companies.
Last May, Durbin chaired a Senate Judiciary Committee hearing entitled “Ensuring Affordable & Accessible Medications: Examining Competition in the Prescription Drug Market.” The hearing examined prescription drug prices, competition, and innovation, and how to ensure medications are accessible and affordable for American families.
In his role as Chair of the Judiciary Committee, Durbin also supported the advancement of a package of bills, which were reported unanimously out of Committee in February 2023, to lower prescription drug prices. The package included Durbin’s Interagency Patent Coordination and Improvement Act, which establishes an interagency task force between the United States Patent and Trademark Office and FDA for purposes of sharing information and providing technical assistance with respect to patents.
A copy of the letter 9amHealth to is available here.
A copy of the letter to Thirty Madison (Cove) is available here.
A copy of the letter to Form Health is available here.
A copy of the letter to Populus Health Technologies is available here.
A copy of the letter to UpScriptHealth is available here.
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