Doctors’ competing interests in Medicare decisions go unchallenged

BMJ 2013; 346 doi: (Published 07 March 2013) Cite this as: BMJ 2013;346:f1558
  1. Edward Davies
  1. 1New York

The conflicts of interest of members of the committees that decide which drugs should be available to people on Medicare are so poorly monitored that financial interests could be influencing decisions, claims a report from federal investigators.1

Medicare’s prescription drug program, known as Part D, provides optional drug benefits to more than 30 million beneficiaries of Medicare. The Centers for Medicare and Medicaid Services (CMS) contracts with private insurance companies, called sponsors, to provide Part D coverage of prescription drugs to beneficiaries who choose to enroll.

But a report from Daniel R Levinson, inspector general at the Department of Health and Human Services, said that the Medicare agency had not clearly defined “conflict of interest” and did not enforce standards meant to prevent such conflicts from influencing panels’ decisions on coverage.

The pharmacy and therapeutic committees of most sponsors have limited definitions of conflicts of interest that could prevent them identifying conflicts, said the report. And many sponsors allow their committee members to determine and manage their own conflicts. Additionally, CMS does not adequately oversee sponsors’ compliance with the requirement that at least two members on each committee be independent and free of interests in the sponsor and in drug manufacturers, the report concluded.

The report says that CMS should require “sponsors to use an objective process to determine whether a disclosed financial interest constitutes a conflict of interest” and that “CMS should oversee sponsors’ P&T [pharmacy and therapeutic] committee conflict-of-interest procedures to ensure that formulary decisions are based only on scientific evidence and standards of practice.”

Ann Maxwell, a regional inspector general in Chicago who worked on the study, said, “We found very little oversight by the insurance companies and the CMS. We found that the agency does not directly oversee insurance companies’ compliance with federal conflict of interest requirements.”


Cite this as: BMJ 2013;346:f1558