Paragraphs 10.4, 11.3 and 12.2 of the Constitution and Procedure for the Prescription Medicines Code of Practice Authority variously authorize the Code of Practice Appeal Board or the Board of Management of the Association of the British Pharmaceutical Industry to require an audit of a company’s procedures in relation to the Code of Practice for the Pharmaceutical Industry to be carried out by the Prescription Medicines Code of Practice Authority.
Set out below are guidelines on company procedures which are regarded as representing good practice in this regard. They are minimum requirements and will need to be adapted to fit in with the arrangements at any particular company. Some of the changes made in the 2016 Code are mentioned in these guidelines but companies should review the documentation on the PMCPA website in relation to the 2016 Code to ensure that they are fully in compliance. The guidelines do not cover all aspects of the Code and are thus no substitute for a detailed study of the Code as a whole, including all of the supplementary information.
1) Scope of the Code
It should be borne in mind that the Code covers some matters that are not necessarily related to promotion. Companies should familiarise themselves with the detail of what is covered and ensure that their procedures are such as to ensure compliance at all times. The supplementary information to Clause
1.1 gives guidance in this regard as does Clause
14.3 which details materials to be certified even if they are non-promotional in nature. Other material issued by companies which relates to medicines but which is not intended as promotion for those medicines, such as corporate advertising, press releases, market research material, financial information for shareholders and the Stock Exchange and responses to unsolicited enquiries from the public etc, should be examined to ensure that it does not contravene the Code or relevant statutory requirements. Account should be taken of the fact that non-promotional material could be used or made available in such a way that it would be considered promotion and thereby come within the scope of the Code.
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Adequate provision should be made in co-promotion agreements and the like to ensure compliance with the Code. Where companies jointly promote the same product and the promotional material bears both company names, the companies concerned will be held jointly responsible for it under the Code. As an alternative to each company separately certifying joint materials, a change made in the 2016 Code allows the companies concerned to agree to have only one final signatory to certify on behalf of all of the companies. This must be agreed beforehand and the PMCPA and the MHRA notified in advance as to whom the signatory will be. In the event of a complaint, each company concerned would remain responsible under the Code (supplementary information to Clause
3) Breaches of the Code
In the event of a company being found in breach of the Code, its procedures should ensure that relevant information about the matter is communicated internally to appropriate members of staff. Procedures must be in place to ensure that material found to be in breach of the Code, and any similar material in any format, is quickly and entirely withdrawn from use, not forgetting material stored electronically and/or in the hands of others, such as printers and agencies. It is important for the reputation of the industry that companies comply with undertakings. Inadequate action leading to a breach of undertaking is likely to be in breach of Clause
2. Companies are advised to keep written records of the action taken to withdraw material.
Companies should bear in mind that promotional material must be up-to-date at the time that it is sent or used or, in the case of a journal advertisement, at the publication date of the journal. Each company must have a senior employee who is responsible for ensuring that it meets the requirements of the Code (Clause
1.12).Unless other formal arrangements have been made by a company, it will be assumed that the responsible person is the managing director or chief executive or equivalent. To assist with compliance, companies should have a comprehensive set of standard operating procedures (SOPs) covering all aspects of the Code. SOPs should set out high standards and relevant staff should be trained and validated on their content.
5) Price Lists for Unlicensed Medicines
Price lists relating to unlicensed medicines are allowed provided that they do not include product claims and make clear that the products are unlicensed (Clause
1.2 and its supplementary information). Such price lists can be sent to health professionals and other relevant decision makers at reasonable intervals or in response to enquiries. They must not be used proactively in a manner which could be seen to be promoting unlicensed medicines, such as by displaying them on exhibition stands.
6) Advance Notification of New Products and Product Changes
Advance notification applies to products or changes which may significantly affect expenditure, which could be significant additional cost or significant savings. Wherever possible information should be provided for inclusion in national horizon scanning databases (supplementary information to Clause
7) Prescribing Information
In certain circumstances Clause
4 of the Code allows elements of the prescribing information to be provided by way of a copy of the summary of product characteristics. The supplementary information to Clause
4.4 covers the use of links to prescribing information. Digital material should provide a link to prescribing information on another website only where the material is expected to be viewed online, such as advertisements in electronic journals.
8) Abbreviated Advertisements
Abbreviated advertisements (Clause
5) must refer to a website where further information about the product can be found. This further information can consist of the prescribing information, as set out in Clauses
4.3, or the summary of product characteristics. Clause
5.4 sets out the information which must be given. It is helpful if promotional material which consists of more than four pages includes a reference as to where the prescribing information can be found.
9) Extremes of Format
Extremes of format, size or cost of promotional material must be avoided (Clause
9.7). All informational or educational materials must be inexpensive, directly relevant to the practice of medicine or pharmacy and directly beneficial to the care of patients.
10) Clinical Trials
Companies must disclose details of clinical trials (Clause
13.1). The supplementary information to Clause
13.1 details how this should be done. Companies must include, on the homepage of their website, information as to where details of their clinical trials can be found.
11) Non-Interventional Studies of Marketed Medicines
A non-interventional study of a marketed medicine is a study where the medicine is prescribed in the usual manner in accordance with the terms of its marketing authorization (Clause
13.2). The assignment of the patient to a particular therapeutic strategy is not decided by a study protocol but falls within current practice and the prescription of the medicine is clearly separated from the decision to include the patient in the study. No additional diagnostic or monitoring procedures are applied to the patients and epidemiological methods are used for the analysis of collected data. A company involved in non-interventional studies must have a scientific service to deal with their approval and supervision as required by Clause
25.2. Companies must publish the summary details and results of non-interventional studies of marketed medicines completed on or after 1 May 2011 (Clause
13.3). This applies to studies with which a UK company has had any involvement. The 2008 Code encouraged companies to publish this information and this still applies to studies completed prior to 1 May 2011. Clause
13.4, which sets out the criteria with which non-interventional studies must comply, applies to studies completed on or after 1 July 2008, though companies are encouraged to comply in relation to studies completed prior to that date.
12) Certification of Promotional Material
13) Certification of Representatives’ Briefing and Training Materials
The certification requirements of Clause
14 apply also to briefing material prepared for representatives in accordance with Clause
15.9. Briefing material includes the training material used to instruct medical representatives about a medicine and the instructions given to them as to how the product should be promoted. Procedures must ensure that no such material is used or issued prior to certification.
14) Certification of Items to be Passed on to Patients
Items which are provided to health professionals for them to pass on to patients must be certified (Clauses
18.2). Such items must be part of a formal patient support programme, the details of which must be appropriately documented and certified in advance.
15) Certification of Other Material
14.3 lists other material which needs to be certified and companies should familiarise themselves with what is covered. Additionally, Clause
14.2 requires the certification of meetings which involve travel outside the UK where a UK company funds UK delegates. In addition all meetings involving travel outside the UK that are wholly or mainly for UK delegates must also be certified. Certain meetings organised and/or funded by overseas pharmaceutical companies need to be examined by the UK company. UK companies also need to examine arrangements for meetings where the UK company’s only role is to select or invite but not fund UK speakers and/or delegates and these meetings are not wholly or mainly for UK delegates. Neither certification nor examination is required if the company’s only involvement is to support a speaker to present at the meeting and there is no pharmaceutical company involvement with the meeting at all (supplementary information to Clause
The Code now allows only very limited provision to health professionals of promotional aids for them to keep and these must be certified (supplementary information to Clause
18.3 and Clause
16) Representatives’ Expenses
There should be a clearly laid down procedure for approval and payment of representatives’ expenses and expenditure on meetings and hospitality and the like. A system should be in place for an audit on a systematic or random basis to check the nature of the expenditure and assess whether that expenditure was in accordance with the requirements of the Code.
17) Representatives’ Training
Procedures must ensure that:
It should be ensured that all relevant personnel, including representatives, members of staff and others retained by way of contract, concerned in any way with the preparation or approval of promotional material or of information to be provided to members of the UK health professions or to other relevant decision makers or of information to be provided to the public and recognised patient organisations, are fully conversant with the requirements of the Code and relevant legal requirements (Clause
16.1). Appropriate arrangements should be in place for training on the requirements of the Code. These may be internal arrangements for appropriate staff members but it is recommended that key personnel attend one of the seminars organised by the Prescription Medicines Code of Practice Authority. All personnel (and others retained by way of contract) must be fully conversant with pharmacovigilance requirements relevant to their work and this must be documented (Clause
16.2). Adequate arrangements should be in place to ensure that any information as to changes to the Code etc, including reports of decided cases, are circulated to relevant personnel. Companies should consider making knowledge of, and compliance with, their obligations in relation to both the Code and pharmacovigilance requirements part of the annual appraisal process for relevant employees. Clause
16.3 sets out the requirements relating to the need for representatives to pass an appropriate examination. Examination status is enquired into when a complaint is received about a representative. Companies should have appropriate procedures in place to ensure that representatives enter for the examination on the earliest practicable date. Representatives must take the examination in their first year of such employment and must pass it within two years of starting such employment. To be acceptable an examination must be accredited to at least Level 3 by an external awarding body recognised by Ofqual. Consequently from 2016 the ABPI only offers accredited examinations. Examinations may also be offered by providers other than the ABPI (Clause 16.3). Representatives commencing such employment on or after 1 October 2014 must take an accredited examination. It was recommended that representatives commencing such employment on or after 1 January 2014 but on or before 30 September 2014 also took an accredited examination. There is more detail in the supplementary information to Clause 16.3.
19) Provision of Medicines and Samples
Companies should ensure that their procedures are such as to ensure compliance with Clause 17. They should be clear as to the distinctions between samples, identification samples, titration packs and free goods etc which are described in the supplementary information to Clause 17. Electronic signatures are acceptable in relation to requests for samples. Not more than four samples of a particular medicine may be provided to an individual health professional during the course of a year (Clause 17.2).
Samples of a medicine can be provided to a health professional for only two years after that health professional first requests samples of it. There is a special provision for the sampling of new medicines which are extensions of existing medicines (Clause 17.2). Medicines covered by Clause 17.6 cannot be provided as samples at all. The supplementary information to Clause 17.7 requires companies to have adequate systems of control and accountability for samples and for all medicines handled by representatives. Similarly, there should be an adequate system to control the number of samples of a particular product given to a particular health professional (Clause 17.2). Samples must not be given for the sole purpose of treating patients (Clause 17.10). Starter packs are not permitted (supplementary information to Clause 17). Starter packs were small packs designed to provide sufficient medicine for a primary care prescriber to initiate treatment in such circumstances as a call out in the night.
20) Items for Patients and Promotional Aids
Previously acceptable promotional aids, such as coffee mugs, stationery and calendars, can no longer be distributed and nor can items for use in a clinic or treatment room, such as surgical gloves, tongue depressors, tissues and the like (supplementary information to Clause 18.1). Toys and puzzles for children to play with cannot be provided either. Items intended to be passed on to patients can be provided to health professionals if these are part of a patient support programme, the details of which have been appropriately documented and certified in advance (Clause 18.2). They must cost no more than £6, excluding VAT, and the perceived value to the health professional and the patient must be similar. They must directly benefit patient care. Such items can be provided to health professionals by representatives during the course of a promotional call but they must not be given out from exhibition stands. In limited circumstances, patient support items can be provided to health professionals when they are not to be passed to patients for them to keep (supplementary information to Clause 18.2). This is where their purpose is to allow patients to gain experience in using their medicines whilst under the supervision of a health professional. Examples are inhalation devices devoid of active ingredients and devices to assist patients to learn how to self-inject. The only items that can be provided to health professionals for them to keep are notebooks, pens and pencils for use at bona fide meetings and conferences etc. No individual should receive more than one notebook and one pen or pencil. The total cost of such items provided to an individual must not exceed £6, excluding VAT, and the perceived value to the recipient must be similar. They must not bear the name of a medicine or any information about medicines but may bear the name of the company providing them (Clause 18.3). They must not be provided by representatives when calling upon health professionals. They must not be given out from exhibition stands. They can be included in conference bags at third party meetings but cannot then bear the name of the company providing them. Memory sticks and DVDs provided in accordance with the supplementary information to Clause 18.1 must be inexpensive. There is much detail in the supplementary information to Clauses 18.1, 18.2 and 18.3 and it is essential that companies familiarise themselves with it.
21) Medical and Educational Goods and Services
The provision of medical and education goods and services must be carried out in compliance with Clause 19 and must be certified in accordance with Clause 14.3. There is much detail in the supplementary information to Clause 19.1.
22) Joint Working, Outcome Agreements, Patient Access Schemes and Package Deals
Joint working between the NHS and the pharmaceutical industry is dealt with in the Code in some detail (Clause 20). An executive summary of a joint working agreement must be made public in relation to joint working projects that started on or after 1 May 2011 or on-going on that date. Certain material relating to joint working must be certified (Clause 14.3). The Code now requires public disclosure of transfers of value in connection with joint working. This applies to transfers of value made in 2015 and each calendar year thereafter (Clause 20). Disclosure of 2015 data is required in 2016. Clause 24 sets out the requirements in relation to transfers of value. The supplementary information to Clause 18.1 deals with outcome or risk sharing agreements, patient access schemes and package deals.
23) Donations and Grants to Institutions, Organisations and Associations
Clause 18.6 of the 2011 Code required pharmaceutical companies to make publicly available details of grants and donations made to institutions, organisations and associations. This applied to donations and grants made in 2012 and each calendar year thereafter. The 2014 Code introduced requirements for public disclosure which differed from those in the Second 2012 Code. These requirements apply to transfers of value made in 2015 and each calendar year thereafter. Disclosure of 2015 data is required in 2016. Clause 24 sets out the requirements in relation to transfers of value. For disclosures in relation to calendar years 2013 and 2014, the requirements and procedures in Clause 18.6 and its supplementary information in the Second 2012 Edition of the Code continue to apply. The Code requires public disclosure of transfers of value in relation to contracts under which institutions etc provide services to pharmaceutical companies (Clause 21 and its supplementary information). This will apply to data for 2015 and each calendar year thereafter. Disclosure of 2015 data is required in 2016. Disclosure must be carried out in accordance with Clause 24.
24) Meetings and Hospitality
A company must have a written document that sets out its policies on meetings and hospitality and the associated allowable expenditure and must ensure that all meetings that it plans are checked to see that they comply with Clause 22. Clause 22.2 stipulates that the cost of a meal (including drinks) provided by way of subsistence must not exceed £75 per person excluding VAT and gratuities. The supplementary information to Clause 22.2 sets out futher details. The maximum of £75 plus VAT and gratuities does not apply to meetings held in European countries where the national association is a member of EFPIA. The local limit would apply instead. Information is available at efpia.eu. Meetings held outside the UK are not necessarily unacceptable but there have to be valid and cogent reasons for the use of a venue outside the UK (supplementary information to Clause 22.1). Meetings which involve travel outside the UK must be certified or examinined as set out in Clause 14.2. This does not apply if the company’s only involvement is to support a speaker to present at the meeting and there is no pharmaceutical company involvement with the meeting. A company’s procedures should cover its own meetings, those which it sponsors and the sponsorship of attendance at meetings. Companies should remind their affiliates that the ABPI Code of Practice must be complied with if UK health professionals attend meetings which they organise regardless of whether such meetings occur in the UK or abroad.
25) Sponsorship to Attend Meetings
The 2011 Code required financial details of sponsorship of UK health professionals and appropriate administrative staff to attend meetings organised by third parties to be made publicly available in respect of sponsorship to attend meetings in 2012 and each calendar year thereafter. The 2014 Code introduced different requirements which applied to both meetings organised by third parties and those organised by pharmaceutical companies. The previous requirements in the Second 2012 Code applied only to meetings organised by third parties.
Disclosure of attendance at meetings in 2015 and each calendar year thereafter is required. Disclosure of 2015 data is required in 2016 (Clause 22.5 and its supplementary information). Disclosure must be carried out in accordance with Clause 24. For disclosure in relation to calendar years 2013 and 2014 the requirements and procedures in Clause 19.4 and its supplementary information in the Second 2012 Edition of the Code still apply.
26) The use of consultants
Health professionals and other relevant decision makers may be used as consultants and advisors for services such as speaking at and chairing meetings, involvement in medical/scientific studies, clinical trials or training services, participation at advisory board meetings, and participation in market research where such participation involves remuneration and/or travel. The arrangements which cover these genuine consultancy or other services must, to the extent relevant to the particular arrangement, fulfil the criteria set out in Clause 23 and procedures should ensure that the requirements of that clause are complied with. Changes were made in relation to the use of consultants in the 2011 Code. In particular, public disclosure of fees paid to consultants in the UK for certain services was required for payments made in 2012 and each calendar year thereafter (Clause 20.2). No disclosure was required in relation to payments for research and development work, including the conduct of clinical trials. Additional information was required to be disclosed in relation to certain payments made in 2013 and each calendar year thereafter (Clause 20.3). The 2014 Code made significant changes in relation to transfers of value to consultants including disclosure on a named individual basis. Transfers of value in relation to research and development work (including the conduct of clinical trials) are to be disclosed on an aggregate basis. These new requirements apply to data for 2015 and each calendar year thereafter. The data for 2015 is to be disclosed in 2016. Disclosure must be carried out in accordance with Clause 24. There is much detail in the supplementary information to Clauses 23.2 and 23.3. For disclosures in relation to calendar years 2013 and 2014, the requirements and procedures in Clauses 20.2 and 20.3 and their supplementary information in the Second 2012 Edition of the Code still apply. Contracts or agreements with consultants entered into or renewed on and after 1 May 2011 must include provisions regarding their obligation to declare the arrangement whenever they write or speak in public about the subject of the agreement or any issue relating to the company (Clause 23.1).
27) Transfers of Value
Transfers of value to health professionals, other relevant decision makers and healthcare organisations must be disclosed (Clause 24). The term ‘transfer of value’ is defined in Clause 1.10 and the supplementary information to Clause 1.10 lists a number of matters which are not transfers of value for the purposes of the Code. Clause 24.2 lists transfers of value covered by Clause 24.1. Transfers of value to patient organisations are not covered by Clause 24. These transfers of value continue to be covered by Clauses 27.7 and 27.8. The matter is complicated as far as the Code is concerned by the fact that it already had disclosure requirements, some of which have been superseded by the requirements derived from the EFPIA Code on Disclosure of Transfers of Value from Pharmaceutical Companies to Healthcare Professionals and Healthcare Organisations. The requirements involve the disclosure of 2015 data and each calendar year thereafter. The 2015 data is to be disclosed in 2016. Disclosure requirements in relation to calendar years 2012, 2013 and 2014 continue to apply. Disclosures must be made in accordance with Clause 24. Companies must disclose using the central UK platform and a standard template (supplementary information to Clause 24.1). Companies should take steps to ensure that they will be able to readily source the information to be publicly disclosed. Each company must publish a note summarising the methodology used to prepare the disclosure and identifying each category of transfer of value.
Procedures should ensure that the methodological note includes:
28) Scientific Services
Companies must ensure that they have an identifiable scientific service to compile and collate all information, from medical representatives or any other source, about the medicines which they market (Clause 25.1). Where relevant, they must also have a scientific service to deal with the approval and supervision of non-interventional studies (Clause 25.2). There can be one scientific service in charge of both responsibilities or separate services with clearly delineated duties.
29) Relations with the Public and the Media
Prescription only medicines must not be advertised to the public but information about them can be provided either directly or indirectly. The provision of information to the public about prescription only medicines must be in accordance with Clause 26. The introduction of a new medicine should only be made known to the public after reasonable steps have been taken to inform relevant health professionals of its availability.
Any material which relates to a medicine and which is intended for patients taking that medicine must include a statement relating to the reporting of side effects. If the medicine is one which is subject to additional monitoring, then the material must include an inverted black equilateral triangle and an additional statement (Clause 26.3).
30) Relationships with Patient Organisations
Pharmaceutical companies can interact with patient organisations or any user organisation such as disability organisations, carer or relative organisations and consumer organisations to support their work, including assistance in the provision of appropriate information to the public, patients and carers (Clause 27). When working with patient organisations, companies must ensure that all of the arrangements comply with the Code. This includes the prohibition on advertising prescription only medicines to the public (Clause 26.1). The requirements of Clause 22, which covers meetings for health professionals and other relevant decision makers, also apply to pharmaceutical companies supporting patient organisation meetings. Companies must ensure that the requirements of Clause 27 are complied with when working with patient organisations. In particular, written agreements must be in place in respect of every significant activity or ongoing relationship (Clause 27.3) and there has to be public disclosure of financial support or indirect/non-financial support. The published information must include the monetary value of financial support and of invoiced costs (Clause 27.7). For significant non-financial support that cannot be assigned a meaningful monetary value, the published information must describe clearly the non-monetary value that the organisation receives. Companies must ensure that their support is clearly acknowledged from the outset. The wording of a declaration of sponsorship must accurately reflect the nature of a company’s involvement. Contracts under which patient organisations provide consultancy or other services to companies are subject to the Code. Clause 27.8 specifies the criteria which contracts for such services must meet, to the extent relevant to the particular arrangement.
A list of patient organisations that have been engaged to provide significant contracted services must be published and updated at least once a year. Companies should ensure that such contracts comply with the criteria in Clause 27.8. Hospitality can be provided in certain circumstances to patient carers (supplementary information to Clause 27.2).
31) The Internet
Companies should ensure that all relevant requirements of the Code, including Clause 28, are complied with in relation to promotional material for prescription only medicines which is provided on the Internet and directed to a UK audience. If access to such material is not limited to health professionals and other relevant decision makers, a pharmaceutical company website or a company sponsored website must provide information for the public as well as promotion to health professionals with the sections clearly separated and the intended audiences identified. Material intended for the public which is provided on the Internet must comply with Clause 26.2.
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