Your health care data is for sale. Here’s how Big Pharma is using it.

Straight Arrow News

Watch Your health care data is for sale. Here’s how Big Pharma is using it. - Straight Arrow News on Dailymotion

Transcript

00:00In this video, we're going to explain how Big Pharma buys your healthcare data and uses

00:05it to target doctors who don't prescribe their drugs.

00:10It sounds like a HIPAA violation.

00:13Insurance companies are selling your healthcare information to pharmaceutical companies so

00:17they can target your doctor.

00:19It's legal because they remove your name and replace it with a number.

00:23They know your age, your sex, your medications, your hospitalizations, your illnesses, and

00:29the zip code where you live.

00:32But as long as your name isn't attached to that information but you're identified by

00:36a number that's considered anonymized, patient-level information and that is compliant with HIPAA

00:44laws.

00:45The prescription data sold by pharmacies de-identifies patient information and replaces doctors'

00:51names with their license numbers.

00:53But here's the key.

00:54The American Medical Association sells access to its Physician Master File, which

00:59contains the license information for nearly every doctor in America.

01:04This gives drug companies everything they need to connect doctors to their prescriptions.

01:08They know exactly what they're prescribing and they also know what they're prescribing it

01:14for because your insurance company sells your health information to these health information

01:21organizations as well.

01:23There's a $9 billion industry called Healthcare Commercial Intelligence that buys all this information

01:29from insurance companies and pharmacies and puts it together in one easy-to-use database.

01:35Drug companies subscribe to these databases and use the information to make inroads either

01:40in a new market or with a new drug.

01:43Definitive Healthcare, for example, sells itself as having all the answers to pharmaceutical companies'

01:48most important questions.

01:49How do you find the physicians who can prescribe your drug?

01:53Who are the key decision makers at your target account?

01:57How big is the market for your new device?

01:59Definitive has profiles on more than 2.6 million physicians, nurses, and other healthcare professionals,

02:06as well as billions of insurance claims on hundreds of millions of patients.

02:11The company updates its database daily.

02:14The physician profiles include clinical activity level, prescription activity level, and their

02:19propensity to prescribe brand name over generic drugs.

02:23So when a drug rep walks into a doctor's office, they have the doctor's profile in hand and a custom

02:28sales pitch based on their patients' data.

02:31I started practicing 30 years ago.

02:33And even back then, the pharmaceutical companies could buy vendor data.

02:37They knew what your prescribing practices were.

02:40And they would use that to target specific medications, specific physicians based on prescribing

02:47patterns.

02:48Dr. Ami Bera has a unique perspective as a medical doctor and as a member of Congress.

02:53It could be used for good if you're not using the medications correctly or it seems like you're

02:58an outlier in those medications.

03:00I'm going to guess most of the time it's used to market those medications and try to get you to switch

03:05from one, let's say, antihypertensive to a different one.

03:09According to a 2022 report from the cloud software company Viva, 60% of healthcare providers meet with

03:15drug reps.

03:16Dr. John Dombrowski, an anesthesiologist based in Washington, D.C., counts himself among

03:20that crowd.

03:21How does that make you feel knowing that the drug rep knows exactly what you've been doing lately?

03:26I mean, that makes me a little uncomfortable.

03:28It seems like Big Brother.

03:29I did not consent to that.

03:31I did nothing about this.

03:32This is all kind of being vacuumed up.

03:35It's very sad that, you know, the American Medical Association is then making profit off

03:40my data that I didn't consent to that they can then sell to Big Pharma.

03:44And what are you trying to get out of a drug rep and your interaction with a drug rep?

03:47What are you hoping to learn?

03:48Basically, I learn as much as I can.

03:50Obviously, I go to meetings.

03:51I have journal club.

03:53And maybe there's a new medication out there that I may not know about that I would certainly

03:57listen to them.

03:58They can leave a leave behind.

03:59Obviously, I know from a drug representative, they're here to push a product.

04:03I know what they're selling and you should always be aware of that.

04:07But just because there's a new product out there doesn't mean it's good or bad.

04:10It means I should take a look at it to see maybe there's something I'm missing.

04:14And that's appropriate.

04:16Pharmaceutical companies spend billions of dollars a year on what's called prescriber detailing,

04:20which is face-to-face sales meetings.

04:22One of the most popular ways to do that is with a meal.

04:26Drug reps take doctors out to dinner or deliver lunch to their office.

04:29In exchange, the doctor listens to the sales pitch while they eat.

04:33Some doctors have become so fed up with drug reps that they either won't meet with them

04:37or have time limits.

04:39Some hospital systems have banned them entirely.

04:42Did you ever have an interaction with a drug rep where it seemed like they might have been

04:44pressuring you?

04:45You know, I never felt pressure.

04:48But again, I think they're doing their job, which is selling their medication.

04:52I think we have to do our job and I think we could do a better job educating medical students

04:57in residency to understand what the real world is going to be like.

05:01So our job is to push back, ask questions, gather information, but then make the most cost-effective

05:07decisions.

05:08This is all allowed under the Health Insurance Portability and Accountability Act of 1996,

05:13or HIPAA, which was written to protect private health information.

05:17HIPAA works by saying to the doctors and the hospitals and the health insurers, here's

05:22a bunch of rules that you have to follow about this data, no matter what the patient says.

05:26The patient gets these rights just by existing.

05:29They don't have to agree to anything.

05:31HIPAA only applies to personally identifiable information, so insurance companies can legally

05:37de-identify information and sell it.

05:39There are two ways to de-identify data, the expert method and the safe harbor method.

05:45The expert method is pretty simple.

05:46An expert must examine the data to ensure there is a very small risk a company could figure

05:51out who it is.

05:53The safe harbor method requires the removal of 18 identifiers, including name, zip code, telephone

05:58numbers, email addresses and social security numbers.

06:02According to the Department of Health and Human Services, de-identified health information

06:06created following these methods is no longer protected by HIPAA.

06:10But they wrote it and said if you go through this de-identification process, essentially

06:14as long as it's still de-identified, you can do whatever you want with the data.

06:17So nobody in that chain knows that you were one of the 400 patients that the doctor prescribed

06:24for any drug.

06:25So the patient data isn't a part of this.

06:29Insurance companies spell out exactly what they do in their disclosures, it's just so

06:33few people read them.

06:35Take Cigna as an example.

06:37Their Notice of Privacy Practices states, in some circumstances we may use your protected

06:41health information to generate aggregate data or summarize data that does not identify

06:46you to study outcomes, costs and provider profiles and to suggest benefit designs for

06:51your employer or health plan.

06:53These studies generate aggregate data that we may sell or disclose to other companies

06:57or organizations.

06:59United has a very similar disclosure.

07:01Their Notice of Privacy Practices states, we may collect, use and disclose health information

07:06needed to operate and manage our business activities related to providing and managing your health

07:10care coverage.

07:11We may also de-identify health information in accordance with applicable laws.

07:16After that information is de-identified, the information is no longer subject to this

07:20notice and we may use the information for any lawful purpose.

07:24Is that a sufficient disclosure in your mind?

07:26I mean that almost exactly word for word tracks the rules pretty much.

07:31SAN reached out to the major insurance companies, health care, commercial intelligence providers

07:35and the nation's largest pharmacy chains.

07:37Despite multiple inquiries, these household names including United, Cigna and CVS never returned

07:43our calls or emails.

07:45But one of the nation's leading privacy and cybersecurity attorneys pushed back on the idea that selling

07:50data is inherently bad.

07:52This idea that your privacy is being violated because your data in an anonymous, de-identified

07:58format is being used for other purposes, there's a disconnect there.

08:03I mean it's a little hard to frame what your privacy interest is in having data that none

08:09of the recipients know is about you.

08:11Nara explained how this practice could help lead to better care for patients because it helps

08:16all health care professionals track what works and what doesn't.

08:20You want to be able to follow a patient across a journey.

08:24I don't care that it's you.

08:26I just need to know that it's the same patient who had this diagnosis on this day, this test,

08:31this procedure, this, you know, whatever they're going to do and had that result.

08:36I need to know that it's the same person in order to evaluate whether it's working and

08:40whether you're doing that across the healthcare system.

08:42I've practiced in 150 specialty medical group.

08:45We would want to have the information to get a sense of how are doctors prescribing, what

08:50are they prescribing, how are they using their medications, so that we could actually

08:55take that feedback and give it back to our doctors, compare them to a panel of their peers

09:01and see where they're at.

09:03That I think is all valuable information, but that's not the pharmaceutical company.

09:08That's the medical group.

09:09That's the hospital system per se.

09:13Interactions between drug reps and medical professionals have changed since the turn

09:16of the century.

09:17In 2002, the Pharmaceutical Research and Manufacturers of America created a code to police interactions

09:22between reps and healthcare professionals.

09:25The self-imposed rules were updated in 2009, further restricting gifts and meals.

09:30For more coverage of the healthcare industry, head to san.com or download the Straight Arrow

09:35News app and search healthcare.

Category

Transcript

Be the first to comment

Recommended