Physician Payments Sunshine Act

US healthcare law that requires manufacturers of drugs, devices, biologicals, or medical supplies to report certain payments or other transfers of value to physicians and teaching hospitals annually.

The Physician Payments Sunshine Act went into effect on August 1 2013 and has the foremost goal to increase transparency by providing patients an easy tool to research whether their healthcare provider receives payments from a pharmaceutical, diagnostic or device company and if so how much, and for what purpose. The collected information is captured in the publicly accessible Open Payments Data website (1).

What needs to be reported and to whom?

Healthcare providers need to report any payments or “transfers of value” in excess of $10 or a combined $100 per year from one manufacturer to the Centers for Medicare & Medicaid Services (CMS). The payments can fall into one of three categories:

  • Research payments – any payments that are associated with research, e.g. grants and funding for pre-clinical research or for clinical studies
  • General payments – everything else, from consulting and speaker fees to lunch, educational materials or travel
  • Value of ownership – captures any ownership or investment interest a physician or immediate family member might have in a company

The total value of payments in 2019 was $10.03 B with a total of 10.98 million records published.

Who falls under the Physician Payments Sunshine Act?

Currently the Physician Payments Sunshine Act applies to physicians and teaching hospitals. The group of healthcare professionals who need to report was expanded by the 2018 SUPPORT ACT which will go into effect on January 1, 2022 and will extend the reporting requirements to physician assistants, nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives.

How is this information important for medical affairs professionals?

In addition to patients, the database is useful for medical affairs professionals who are identifying and prioritizing external experts. The information can help medical affairs professionals to:

  • Establish an expert’s affinity for industry collaborations, e.g. consulting/advisory, clinical trials
  • Identifying the most frequently engaged experts in a therapeutic field indicates a clear willingness to partner with industry.
  • Insights related to spend volume for promotional education activities for a particular drug class or field of therapy.
  • Highlighting experts that have recent funding from direct competitors.
  • Performing competitive intelligence by identifying expert relationships you share across companies, experts who have yet to be engaged, and how relationships change over the course of an expert’s career.

Industry payments provide valuable information about scientific and medical experts and can lead to actionable insights, especially when considered in the context of an expert’s 360-degree profile.

(1) https://www.cms.gov/openpayments/

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