AUTH/2017/7/07 Anonymous v Teva: Asthma review service and representative involvement in prescribing decisions

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Key facts

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Case number	AUTH/2017/7/07
Parties	Anonymous representative v Teva UK Limited
Product / therapy area	Qvar (CFC-free beclometasone); asthma
Activity	Enhanced Asthma Care Service (asthma review service) provided by an agency
Core issue	Representative involvement in completion of Practice Treatment Mandate section recording prescribing decision; perceived pressure to specify Qvar
Complaint received	03 July 2007
Case completed	10 December 2007
Applicable Code year	2006
Panel decision (initial)	Breaches ruled for Clauses 15.9, 18.1, 18.4, 9.1 and 2 (15.9 accepted; others appealed)
Appeal Board decision (final)	Breach of Clause 18.4 upheld; no breach of Clause 18.1, 9.1, or 2
Final breach clauses	Clause 15.9 and Clause 18.4
Sanctions	Undertaking received

Reviewed by Dr Anzal Qurbain (FFPM) — ABPI Final Signatory

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An anonymous Teva sales representative complained about pressure on reps to meet targets for Qvar by signing GP surgeries up to the “Enhanced Asthma Care Service” (EACS), delivered by an agency.
The complainant alleged reps were expected to sign up at least six surgeries per year and that it was a “big issue” if targets were missed or if paperwork did not specify a switch to Qvar or Qvar Easi-Breathe.
The service was positioned as non-promotional and intended to support asthma reviews (including in the context of CFC inhaler phase-out), but materials included references to identifying “controlled” patients for a straight change to a CFC-free equivalent and included an “Immediate Medication Change” template letter.
The Panel raised concerns that the overall arrangements and mixed messaging could facilitate a prohibited “switch service” (switching without clinical assessment) and queried the representative’s ongoing role and presence in practice processes.
On appeal, the Appeal Board accepted the service was offered before prescribing choices were known (so not inherently linked to prescribing), but focused on the Practice Treatment Mandate section that recorded prescribing decisions being completed with the representative present.

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Breach found: Clause 15.9 and Clause 18.4.
No breach (on appeal): Clause 18.1, Clause 9.1, and Clause 2 (these Panel findings were overturned by the Appeal Board).
The Appeal Board held it was unacceptable for a representative to be present when the GP recorded prescribing decisions, as it was highly likely the GP would feel pressurised to specify Qvar where appropriate.

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