A physicians' union is encouraging its 8,500 members nationwide to avoid prescribing drugs manufactured by Merck & Co. because one of the drug company's subsidiaries opposed an antitrust exemption for physicians.
Merck-Medco Managed Care LLC, a pharmacy benefit manager, was a member of a coalition that's lobbying against federal legislation that would grant independent physicians an antitrust exemption. The exemption would allow competing physicians to collectively bargain with health plans over fees and other issues.
Current antitrust laws bar competitors from collectively setting prices for their services. Unionized workers already are exempt from that antitrust prohibition, so the legality of the physician union's actions is unclear.
Greg Reaves, a spokesman for Merck, said that Merck-Medco joined the coalition because the legislation also would allow pharmacists to collectively bargain over fees, which could drive up costs. Merck-Medco ultimately withdrew from the coalition but not because of the boycott, Reaves said.
"The coalition had mistakenly circulated materials with (parent company) Merck's name on them," Reaves said. "But Merck has never taken a position on this bill. Merck-Medco decided that the best way to clarify this misimpression was to withdraw from the coalition."
Reaves said he did not know when Merck-Medco withdrew from the coalition.
The bill, sponsored by Rep. Thomas Campbell (R-Calif.), was slated for a House vote last week, but the vote was postponed (See story, this page).
"We never called for a `boycott,' " said Jack Seddon, executive director of the Tallahassee, Fla.-based Federation of Physicians and Dentists. "We just put the word out to our members that they should look at this list (of coalition members) and reward their friends and punish their enemies."
Seddon estimated that thousands of doctors were refusing to prescribe Merck products, which include vaccines and such well-known drugs as Pepcid and Propecia. But he said that when no other drugs were available or comparable, physicians were prescribing Merck drugs.
"We're not going to sacrifice patient care," Seddon said.
Merck's Reaves declined to comment on the patient-care implications of the boycott.
The American Medical Association, the chief backer of the Campbell bill, does not condone the federation's effort, said Donald Palmisano, M.D., a New Orleans surgeon and AMA board trustee.
"We don't mix our clinical care with politics," Palmisano said. "We recommend that all physicians use the best treatment for the patient."
Seddon said the federation wants Merck to publicly explain its actions by sending letters to every member of Congress and taking out a full-page ad in the Washington Post. Otherwise, the boycott will continue.
"They can tell Congress the same thing they told me," Seddon said. "They owe it to the physicians who feather their pockets."
Reaves said Merck believes it has already made its position clear and does not intend to meet the federation's demands.
Coalition members say the federation's behavior illustrates what could happen if competing physicians win an antitrust exemption.
"This certainly does seem to be a boycott," said Robert Leibenluft, a former Federal Trade Commission official who is now legal counsel to the coalition. "What it reflects are the kinds of concerns that people have about giving an antitrust exemption to physicians. The notion of switching over from drugs one would normally prescribe to something else raises some ethical questions."
Other coalition members include the American Association of Health Plans, the American Nurses Association, the Healthcare Leadership Council and the U.S. Chamber of Commerce.