Sunshine For All

In May 2018, Senators Chuck Grassley (R-IA), Sherrod Brown (D-OH), and Richard Blumenthal (D-CT) introduced the Fighting the Opioid Epidemic with Sunshine Act to shed light on how our opioid crisis developed and what is driving it. As noted earlier in this White paper, there is now some limited light shining on costs via the Open Payments database and website created by the CMS, as required under Senator Grassley’s Physician Payments Sunshine Act. 33 A bipartisan bill of May 2018 would extend transparency to include Nurse Practitioners (NPs) and the Physicians Assistants (PAs), who can write prescriptions in 23 states. While expressly designed to shine light on prescriptions for opioids, this legislation should include all prescriptions. Interestingly, according to CMS data, NPs account for a significant number of opioid prescriptions. In fact, they are the main prescribers of opioids in some states.34 Senator Claire McCaskill (D-MO) added (then retracted) a provision that would have included transparency for the money passing between pharmaceutical manufacturers and physician advocacy groups. She amended this to include transparency ONLY for opioid manufacturers. Her initial idea had great merit, and we suggest expanding it to include funding provided by pharmaceutical manufacturers or pharmaceutical channeling companies (including PBMs, GPOs, and the distributors Cardinal Health, McKesson Corporation, and AmerisourceBergen) as well as Medical Insurance Companies. There is a welter of conflicts of interest in these relationships, with their payments made to and sponsorships provided for:

  • Physician advocacy groups
  • Think tanks
  • Patient advocacy groups Coalitions

This transparency should be retroactive in the interest of establishing the histories of potential conflicts of interest.

WE ASK that there be Sunshine for All. The following should be made fully transparent—funding that flows from pharmaceutical companies and pharmacy channel companies (such as PBMs and GPOs, which include the nation’s three big distributors) to physician advocacy groups, such as professional societies of medical care providers, consumer advocacy organizations, patient-education organizations, providers of continuing education, co-pay assistance organizations, and think tanks. This transparency should be retroactive, so as to establish histories of possible conflicts of interest.

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