Merck touches off Canadian controversy with Januvia doctor survey

Payers pressing for lower prices. Drugmakers paying doctors. Two of the most contentious issues in pharma these days. Put the two together, and what do you have? A tempest in British Columbia.

That Canadian province's Pharmacare program stopped covering Merck's ($MRK) Januvia last week. Less expensive drugs in the same class were available to do the same job, officials reasoned; 35% less expensive, in fact.

But Merck, obviously, disagreed with the choice. The drugmaker funded a survey about Januvia's delisting, via a grant to the Canadian Heart Research Centre, the company told The Wall Street Journal.

The survey would be conducted by a group of doctors called B.C. Voice, the Vancouver Sun reports. B.C. Voice distributed its survey to 4,500 fellow physicians, both specialists and primary-care docs, and paid $150 to each of 331 doctors who responded.

Were the doctors consulted about the change? Well, no. Fewer than 20 doctors were asked directly ahead of time, and fewer than that were consulted indirectly. Most of them knew--or figured out--that the government's reason for restricting Januvia coverage had to do with cost.

The questions grow more pointed after that: Did you have to explain the coverage change to your patients? Will your patients have to come in for new appointments because of the change? Will new lab tests be required? What worries you most about switching Januvia patients to another DPP-4 drug?

But the zinger is this one (and we're paraphrasing here): Is it in patients' best interest to switch them to an alternative drug for cost reasons? Some 85% of physicians agreed that it is not.

Those are overwhelming numbers. But the survey results are drawing fire. B.C. officials point out that Merck sponsored the survey--a fact disclosed only in the fine print--and that B.C. Voice doctors had received research grants, consulting fees or speaking fees from the company. B.C. Health Minister Terry Lake called the survey questions "leading, speculative and biased."

"We feel the survey is really a lobbying effort on the part of a large pharmaceutical company," Lake told the Sun.

Graydon Meneilly

Dr. Graydon Meneilly is a B.C. Voice co-chair, and he happens to also be an expert in diabetes in the elderly. He readily admitted to the Vancouver Sun that he had taken speaking and consulting payments from drugmakers, including Merck, saying he didn't think the fees he's received would cloud his opinions. "I agree there are some inherent conflicts of interest involved" in the survey, Menielly said. "But I also don't think Pharmacare was entirely transparent with this issue."

Merck tells the WSJ that the company funded the study "because we believed that it was important to understand physicians' perspective on the impact of the delisting of [Januvia] in British Columbia on patient care."

Meneilly has a particular perspective. He got involved in the survey because he was upset about the change, he told the Sun, and especially peeved that the government didn't consult B.C. doctors before they decided. And, he says, switching his elderly Januvia patients to another drug has led to some complications.

- get the Vancouver Sun story
- read the WSJ piece
- see the survey results

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