SUPPLEMENT Lilly’s consumer protection settlement regarding Zyprexa: Compliance provisions Here are the compliance requirements included in Eli Lilly’s $62 million consumer protection settlement with 32 states announced October 7, 2008: 1. Promotional Activities
symptoms and the relevant diagnostic criteria
are available in the Diagnostic and Statistical
A. Lily shall not make any written or oral claim that
is false, misleading or deceptive regarding
II. Dissemination of Medial Information
B. For six years from the Effective Date of this
Judgment, Lilly shall not Promote Zyprexa for
A. General Terms
1. The content of Lilly’s communications
C. For six years from the Effective Date of this
concerning Off-Label uses of Zyprexa shall
Judgment, Lilly shall not present patient profiles/
not be false, misleading or deceptive.
FDA-approved indication(s) when promoting
B. Medical Letters and Medical References
1. The following subsections shall be effective for
six years from the Effective Date of this
indication(s) being Promoted is/are stated
clearly and conspicuously in the same spread
(i.e. on the same page or on the facing page) in
2. Lilly Medical shall have ultimate responsibility
for developing and approving the medical
content for all Medical Letters and Medical
References regarding Zyprexa, including any
a. With respect to Promotional Slide Kits:
that may describe Off-Label information.
Additional approvals may be provided by Lilly
Regulatory and Lilly Legal. Lilly shall not
indication(s) on the same slide in which
a. Clinically Relevant Information is included
in these materials to provide scientific
Section I.C.1.a.(i) on the same slide as each
b. Data in these materials are presented in an
subsequent reference to selected symptoms
(e.g., “See complete list of FDA-approved
c. These materials are distinguishable from
sales aids and other Promotional Materials.
(iii) Lilly shall require any presenter of
Lilly’s Promotional Slide Kits to present the
3. Lilly Sales and Lilly Marketing personnel shall
statement required in Section I.C.1.a (i), as
not develop the medical content of Medical
Zyprexa. This provision does not prohibit
2. Promotional Materials have a reference
Lilly Sales or Lilly Marketing personnel from
indicating that the full constellation of
suggesting topics for Medical Letters or
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4. Lilly Sales representatives shall not distribute
orally to an Unsolicited Request for Off-Label
any Medical Letter describing any Off-Label
only by informing the HCP of the presence or
misleading representation regarding Zyprexa
absence of published studies concerning the
Off-Label topic or acknowledge whether the
topic is an area of research, and by offering to
request on behalf of the HCP that a Medical
C. Responses to Unsolicited Requests for
Letter or other information set forth above in
Off-Label Information
II.C.4 be sent to the HCP in follow up. Lilly
Non-Medical personnel shall not characterize,
1. The following subsections shall be effective for
describe, identify, name, or offer any opinions
six years from the Effective date of this
2. In responding to an Unsolicited Request for
D. Reprints
Off-Label information regarding Zyprexa,
including any request for a specific article
1. The following subsections shall be effective for
related to Off-label uses, Lilly shall advise the
six years from the Effective Date of this
Off-Label use and inform the requester of the
drug’s FDA-approved indication(s) and or/
2. Reprints Containing Off-Label Information
a. Lilly Medical shall be responsible for the
3. If Lilly elects to respond to an Unsolicited
Request for Off-Label information form HCP
Off-Label Information regarding Zyprexa.
regarding Zyprexa, Lilly Medical personnel
shall provide specific, accurate,objective and
b. Reprints Containing Off-Label Information
scientifically balanced responses. Any such
response shall not Promote Zyprexa for an
prescribing information for the product and
4. Any written response to an Unsolicited
contain a disclosure in a prominent location,
Request for Off-Label information regarding
which would include the first page or as a
cover page where practicable, indicating
a. an existing Medical Letter prepared in
(ii) shall not be referred to or used in a
b. a Medical Letter or other document such as
slides prepared in response to the request in
c. Reprints Containing Off-Label Information
disseminated by Lilly Medical personnel to
reasonable literature search using terms
not disseminate these materials to HCPs,
absent to the exception described below in
5. Lilly Non-Medical personnel may not respond
in writing to an Unsolicited Request for
Off-Label information regarding Zyprexa.
circumstance in which there is a clinical
6. Lilly Non-Medical personnel may respond
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personnel disseminate a Reprint Containing
Off-Label Information directly to HCPs, the
E. Health Care Economic Information
prohibition described in Section II.D.2.c
above for the Reprint Containing Off-Label
1. Nothing in this Judgment shall preclude Eli
Lilly from providing Health Care Economic
Information to a formulary committee or other
(ii) If the Clinical Necessity Exception is
similar entity or its members on the course of
invoked, Lilly will notify each Signatory
the committee or entity carrying pursuant to
Attorney General of its intent to invoke the
the standards of FDAMA Section 114 if the
Clinical Necessity Exception at least 30
information directly relates to an approved
business days prior to disseminating through
indication for Zyprexa and if it is based on
Lilly Sales representatives of any Reprint
competent and reliable scientific evidence. III. Continuing Medical Education (CME) and
A. The following subsections shall be effective for six
years from the Effective Date of this Judgment.
Necessity Exception, then the State will
B. Lilly shall disclose information about grants,
provide Lilly with written notice within
consistent with the current disclosures of the Lilly
opportunity to discuss its desired use of
Grant Office Registry at Zyprexa consistent with
the current disclosures of the Lilly Grant Office
Registry at www.lillygrantoffice.com (hereinafter,
“LGO website”) or as required by applicable law.
(b) If the State and Lilly do not come to
1. Lilly shall maintain this information on the
a resolution, then the State may initiate
LGO website once posted for at least two
legal action to prevent the dissemination
years and shall maintain the information in a
readily accessible format for review by States
upon written request for a period of five years.
C. The Lilly Grant Office shall manage all requests
(c) If the State initiates legal action to
for funding related to CME regarding Zyprexa.
prevent the dissemination of the Reprint
Approval decisions shall be made by Lilly Grant
Office alone, and shall be kept separate from the
Lilly Non-Medical personnel, Lilly shall
D. Lilly shall not use grants to Promote Zyprexa.
Off-Label Information in that State until
This provision includes, but is not limited to, the
3. Nothing in this Judgment shall preclude Lilly
1. Lilly Sales and Lilly Marketing personnel shall
from disseminating reprints which have an
not initiate, coordinate or implement grant
incidental reference to Off-Label information.
applications on behalf of any customer or
If reprints have an incidental reference to
Off-Label information, such reprints shall
contain the disclosure required by Section
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2. Lilly Sales and Lilly Marketing personnel shall
B. This Section shall apply to the U.S. based
not be involved in selecting grantees or
Consultants and Promotional Speakers to the
3. Lilly Sales and Lilly Marketing personnel shall
C. Lilly shall provide to each Signatory Attorney
not measure or attempt to track in any way the
General, in an electronic spreadsheet format, a
impact of grants or speaking fees on the
participating HCP’s subsequent prescribing
Consultants who were paid by Lilly any taxable
income in excess of $100 for Promotional
speaking and /or Consulting performed for Lilly
E. Lilly shall not condition funding of a CME
in the U.S., a list of all titles of Promotional
program grant request regarding Zyprexa upon
presentations made, and the following additional
the requestor’s selection or rejection of particular
information with respect to each individual
F. Lilly shall not suggest, control, or attempt to
1. total compensation from Lilly for any
influence selection of the specific topic, title,
content, speakers or audience for CME’s
regarding Zyprexa, consistent with ACCME
2. total number of Promotional speaking events
G. Lilly Sales and Lilly Marketing personnel shall
3. the state the Promotional Speaker/Consultant
not approve grant requests regarding Zyprexa,
had provided to Lilly for contact purposes.
nor attempt to influence the Lilly Grant Office to
reward any customers or HCP’s with grants for
4. the state(s) in which the Promotional Speaker
their prescribing habits, practices or patterns.
H. Lilly shall contractually require the CME provider
5. any other compensation from Lilly as set forth
to disclose to CME program attendees Lilly’s
in IRS Form 1099. On or before July 1, 2009,
financial support of the CME program and any
Lilly shall provide the data requested in Nos.
financial relationship with faculty and speakers at
1-4 for the period January 1, 2009-March 31,
such CME. As part of the disclosure of a financial
2009. On or before October 1, 2009 Lilly shall
relationship with faculty and speakers, Lilly shall
provide the data requested in Nos 1-4 for the
contractually require the CME program to
period April 1, 2009-June 30, 2009. On or
identify the URL of a Lilly website, and reference
before January 1, 2010, Lilly shall provide the
that website as the source for further information
date requested in Nos 1-4 for the period July
concerning grant funding regarding Zyprexa.
April 1, 2010 and on or before April 1 each
I. After the initial delivery of the CME program, Lilly
subsequent year, Lilly shall provide the data
shall not fund the same program, nor shall it
requested in Nos 1-5 for the full preceding
provide additional funding for re-distribution of
the same program, if it knows the program’s
speakers are Promoting Zyprexa for Off-Label
D. Lilly shall disclose to the Promotional Speaker or
Consultant that the information in Section IV.C.
IV. Payments to Consultants and Speakers
A. The following subsections shall be effective for six
years from the Effective Date of this Judgment. Rx ComplianCe RepoRt 4 V. Product Samples
accessible website of all Lilly-sponsored Phase
II, III, and IV clinical trials that were
A. The following subsections shall be effective for six
years from the Effective Date of this Judgment.
B. When presenting information about a clinical
B. Lilly Sales representatives may only sample
study regarding Zyprexa in all Promotional
Zyprexa to HCP whose clinical practice is
Materials, Lilly shall not do any of the following
consistent with the product’s current Labeling.
Currently, Lilly samples Zyprexa to the following
practices: emergency medicine, family practice,
general practice, internal medicine, and
1. present favorable information or conclusions
from a study that is inadequate in design,
scope, or conduct to furnish significant support
C. If a HCP whose clinical practice is inconsistent
with the product’s Labeling requests samples,
Lilly personnel shall refer the practitioner to
2. use the concept of statistical significance to
1-800-LillyRx where the practitioner can speak
directly with a Lilly representative who will
demonstrated to have clinical significance or
provide answers to their questions about Zyprexa
validity, or fails to reveal the range of
variations around the quoted average results;
appropriate (i.e., if the physician requests the
3. use statistical analyses and techniques on a
retrospective basis to discover and cite findings
VI. Clinical Research
not soundly supported by the study, or to
suggest scientific validity and rigor for data
A. Lilly shall report research regarding Zyprexa in an
from studies the design or protocol of which
accurate, objective and balanced manner as
1. To the extent permitted by the National
4. present the information in a way that implies
Library of Medicine and as required by the
that the study represents larger or more
general experience with the drug than it
110-85), Lilly shall register clinical trials and
submit results to the registry and results data
bank regarding Zyprexa as required by FDA
5. use statistics on numbers of patients, or counts
of favorable results or side effects, derived
regulations that may be promulgated pursuant
from pooling data from various insignificant or
to the act. With the respect to Zyprexa, Lilly
dissimilar studies in a way that suggests either
will register on a publicly accessible website
that such statistics are valid if they are not they
the initiation of all Lilly-sponsored Phase II,
are derived from a large or significant studies
III, and IV clinical trials beginning after July 1,
supporting favorable conclusions when such is
2005 and will post results on a publicly
Rx ComplianCe RepoRt 5
Tetracycline administered in water: pharmacokinetics and lessons for administration of other medications via water Sharon Mason1 Ronald Baynes1 Glen Almond1 Jim Riviere1 Alan Scheidt2 1. North Carolina State University, Raleigh, NC, USA; 2. Pfi zer Animal Health, Kalamazoo, MI, USA Introduction Table 1: Pharmacokinetic parameters of tetracycline The use of medications dosed in w
To: James C. Boylan, Ph.D., Chairperson Executive Committee General Policies and Requirements Division, GPR United States Pharmacopeia Council of ExpertsSubject: Report of Parenteral Products – Compounding and PreparationCommittee (known informally as “The Sterile Compounding Committee”)From: David W. Newton, Ph.D., Committee ChairpersonDear Jim, Fellow GPR Chairpersons, and Sterile Compo