2021 ABPI Code of Practice for the Pharmaceutical Industry PDF

ABPI CODE OF PRACTICE FOR THE PHARMACEUTICAL INDUSTRY 2021  ABPI CODE OF PRACTICE for the PHARMACEUTICAL INDUSTRY 2021...

ABPI CODE OF PRACTICE FOR THE PHARMACEUTICAL INDUSTRY 2021  ABPI CODE OF PRACTICE for the PHARMACEUTICAL INDUSTRY 2021 together with the PRESCRIPTION MEDICINES CODE OF PRACTICE AUTHORITY Constitution and Procedure This edition of the Code of Practice comes into operation on 1 July 2021. There is no transition period other than for companies wishing to continue with ongoing Medical and Educational Goods and Services where there is a transition period until 31 December 2021 as set out in the supplementary information to Clause 23. The template for disclosure agreed for the 2021 Code should be used to submit the 2021 data to Disclosure UK in 2022.  THE PRESCRIPTION MEDICINES CODE OF PRACTICE AUTHORITY The Prescription Medicines Code of Practice Authority (PMCPA) was established by the Association of the British Pharmaceutical Industry (ABPI) in 1993 to operate the Code of Practice for the Pharmaceutical Industry independently of the Association itself. Complaints should be submitted to the Director of the Prescription Medicines Code of Practice Authority, 7th Floor, Southside, 105 Victoria Street, London SW1E 6QT, telephone 020 7747 8880, email [email protected]. Complaints made under the Code are considered by the Code of Practice Panel and, where required, by the Code of Practice Appeal Board. Reports on cases are published by the Authority and are available on request and on the Authority's website www.pmcpa.org.uk. The PMCPA is a division of the ABPI which is a company limited by guarantee registered in England and Wales, No 09826787. Registered office: 7th Floor, Southside, 105 Victoria Street, London SW1E 6QT. © Copyright 2021 Association of the British Pharmaceutical Industry. 02  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 Contents 2021 CODE AND 2019 CODE CLAUSES COMPARED YELLOW SECTION – INTERACTIONS WITH HEALTH....................................................................................................... 04 PROFESSIONALS, OTHER RELEVANT DECISION MAKERS, HEALTHCARE ORGANISATIONS, PATIENT ORGANISATIONS ABPI PRINCIPLES AND THE PUBLIC, INCLUDING PATIENTS AND JOURNALISTS....................................................................................................... 05 CLAUSES 23–25 ABPI CODE OF PRACTICE FOR THE PHARMACEUTICAL Clause 23: Donations and Grants................................................. 39 INDUSTRY INTRODUCTION Clause 24: Contracted Services.................................................... 41....................................................................................................... 06 Clause 25: Relationships with Health Professionals, Other Relevant Decision Makers, Healthcare Organisations GREY SECTION – OVERARCHING REQUIREMENTS and Patient Organisations............................................................ 43 CLAUSES 1–10 PINK SECTION – SPECIFIC REQUIREMENTS FOR INTERACTIONS WITH THE PUBLIC, INCLUDING PATIENTS Clause 1: Scope of the Code and Definition of Certain Terms...... 08 Obligations and Responsibilities AND JOURNALISTS, AND PATIENT ORGANISATIONS Clause 2: Upholding Confidence in the Industry............................ 11 CLAUSES 26–27 Clause 3: Obligations...................................................................... 11 Clause 4: Responsibilities.............................................................. 13 Clause 26: Relations with the Public, Including Patients and Journalists................................................................. 44 Quality Standards Clause 27: Relationships with Patient Organisations................... 47 Clause 5: High Standards and Suitability....................................... 14 Clause 6: Information, Claims, Comparisons TEAL SECTION – ANNUAL DISCLOSURE REQUIREMENTS and Disparagement........................................................................ 14 Clause 7: Use of Quotations.......................................................... 16 CLAUSES 28–31 Clause 8: Certification and Examination....................................... 16 Clause 28: Annual Disclosure of Transfers of Value to Clause 9: Training........................................................................... 18 Health Professionals, Other Relevant Decision Makers and Healthcare Organisations...................................................... 48 Clause 10: Events/Meetings and Hospitality................................. 20 Clause 29: Annual Disclosure of Contracted Services, Donations, Grants and Sponsorship (including in relation BLUE SECTION – PROMOTION TO HEALTH PROFESSIONALS to events/meetings) Provided to Patient Organisations.............. 49 AND OTHER RELEVANT DECISION MAKERS Clause 30: Annual Disclosure of Contracted Services CLAUSES 11–17 Provided by the Public, Including Patients and Journalists........... 49 Clause 31: Timings, Duration and Retention Clause 11: Marketing Authorisation and Temporary of Disclosure Information............................................................... 50 Supply Authorisation..................................................................... 24 Clause 12: Prescribing Information and Other PRESCRIPTION MEDICINES CODE OF PRACTICE Obligatory Information.................................................................. 25 Clause 13: Abbreviated Advertisements......................................... 27 AUTHORITY CONSTITUTION AND PROCEDURE Clause 14: Information, Claims and Comparisons........................ 29........................................................................................................ 51 Clause 15: High Standards, Format and Suitability....................... 30 GUIDELINES ON COMPANY PROCEDURES Clause 16: Material and Distribution............................................. 30 RELATING TO THE ABPI CODE OF PRACTICE Clause 17: Representatives............................................................. 31...................................................................................................... 64 GREEN SECTION – INTERACTIONS WITH HEALTH LEGISLATION, OTHER CODES AND GUIDELINES PROFESSIONALS, OTHER RELEVANT DECISION MAKERS....................................................................................................... 65 AND HEALTHCARE ORGANISATIONS CLAUSES 18–22 In the Code of Practice, guidance on the interpretation of the Code Clause 18: Information, Claims and Comparisons........................ 33 appears as supplementary information to the text against a pale Clause 19: Prohibition on Inducements and Inappropriate coloured background. Payments and the Provision of Items to Health Professionals and Other Relevant Decision Makers............................................ 33 Clause 20: Collaborative Working with Organisations................. 35 Clause 21: Provision of Medicines and Samples........................... 37 Clause 22: Non-Interventional Studies of Marketed Medicines... 38 03  2021 CODE AND 2019 CODE CLAUSES COMPARED The table below provides a comparison of the 2021 Code clauses to the relevant 2019 Code clauses, to support familiarisation with the changes. The numbers in brackets beside each clause or supplementary information throughout the 2021 Code are those from the 2019 Code. 2021 Code Clauses 2019 Code Clauses Grey Section – Overarching Requirements Clause 1 Scope of the Code and Definition of Certain Terms 1.1, 28.2, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 1.10, 13.2, 17 SI, 23.2 SI, 24.1 SI, 27.1 Obligations and Responsibilities Clause 2 Upholding Confidence in the Industry 2 Clause 3 Obligations 1.11, 1.12, 3.1, 12.1, 26.1, 29 Clause 4 Responsibilities 13.1, 13.3, 24.1, 25.1, 25.2, 26.5, 27.7, 27.8 Quality Standards Clause 5 High Standards and Suitability 9.1, 9.2, 9.3, 9.7, 9.10, 11.1, 28.6 Clause 6 Information, Claims, Comparisons and Disparagement 7.2, 7.4, 7.8, 7.9, 7.11, 8.1, 8.2 Clause 7 Use of Quotations 10.2, 10.3 Clause 8 Certification and Examination 14.1, 14.2, 14.3, 14.4, 14.5, 14.6 Clause 9 Training 15.1, 16.1, 16.2, 16.3, 16.4 Clause 10 Events/Meetings and Hospitality 18.1 SI, 18.3, 18.3 SI, 22.1, 22.1 SI, 22.2, 22.3, 22.4, 22.5, 24.2, 27.3 Blue Section – Promotion to Health Professionals and Other Relevant Decision Makers Clause 11 Marketing Authorisation and Temporary Supply Authorisation 3.1, 3.2 Clause 12 Prescribing Information and Other Obligatory Information 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 4.10 Clause 13 Abbreviated Advertisements 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9 Clause 14 Information, Claims and Comparisons 6.2, 7.3, 7.6, 7.7, 7.10 Clause 15 High Standards, Format and Suitability 9.4, 9.5, 9.6, 9.8, 9.9, 12.1 Clause 16 Material and Distribution 10.1, 11.2, 11.3, 28.1, 28.4 Clause 17 Representatives 15.1, 15.2, 15.3, 15.4, 15.5, 15.6, 15.7, 15.8, 15.9, 15.10 Green Section – Interactions with Health Professionals, Other Relevant Decision Makers and Healthcare Organisations Clause 18 Information, Claims and Comparisons 7.1, 7.5 Clause 19 Prohibition on Inducements and Inappropriate Payments and 18.1, 18.2 the Provision of Items to Health Professionals and Other Relevant Decision Makers Clause 20 Collaborative Working with Organisations 20, 24.2 Clause 21 Provision of Medicines and Samples 17.1, 17.2, 17.3, 17.4, 17.5, 17.6, 17.7, 17.8, 17.9, 17.10 Clause 22 Non-Interventional Studies of Marketed Medicines 13.4 Yellow Section – Interactions with Health Professionals, Other Relevant Decision Makers, Healthcare Organisations, Patient Organisations and the Public, Including Patients and Journalists Clause 23 Donations and Grants MEGS in the form of Donations and Grants in 19.1, 19.2 Clause 24 Contracted Services 21, 23.1, 23.2, 23.3, 23.4 (27.8 incorporated) Clause 25 Relationships with Health Professionals, Other Relevant Decision Makers, 27.4, 27.5, 27.9, 12.2 Healthcare Organisations and Patient Organisations Pink Section – Specific Requirements for Interactions with the Public, Including Patients and Journalists, and Patient Organisations Clause 26 Relations with the Public, Including Patients and Journalists 18.2 SI, 26.1, 26.2, 26.3, 26.4 Clause 27 Relationships with Patient Organisations 27.1, 27.2, 27.3, 27.5, 27.6 Teal Section – Annual Disclosure Requirements Clause 28 Annual Disclosure of Transfers of Value to Health Professionals, Other 24.1, 24.2, 24.7, 24.8, 24.9, 24.10 Relevant Decision Makers and Healthcare Organisations Clause 29 Annual Public Disclosure of Contracted Services, Donations, Grants and EFPIA Requirement, 27.7, 27.8 Sponsorship Provided to Patient Organisations Clause 30 Annual Public Disclosure of Contracted Services Provided by the Public, ABPI Requirement Including Patients and Journalists Clause 31 Timings, Duration and Retention of Disclosure Information 24.4, 24.5, 24.6 04 ABPI PRINCIPLES The following principles for pharmaceutical companies are seen Ethical relationships with stakeholders are critical to our by the ABPI as key to how we operate as an industry and build mission of helping patients, guiding the appropriate use of our trust and enhance our reputation. Companies are expected to medicines and ensuring the appropriate and timely exchange implement and work to embed these into their organisation. of scientific information. Patients are at the heart of our industry. We aspire to ensure that An important guide for such ethical relationships is adherence everything we do will ultimately benefit patients. Our primary to the ABPI Code of Practice which, among other things, sets contribution to society is to research and develop high quality the standards and drives an ethical culture in the industry. This medicines and to encourage their appropriate and rational use. is delivered through self-regulation. Our industry, and the Patient safety is paramount. individuals within it, are committed to supporting that culture, working within both the letter and the spirit of the ABPI Code and all relevant laws and regulations. In adhering to the ABPI Code, we follow four key principles: Principles developed by the ABPI Some examples of how we demonstrate the principle in our behaviour 1. W  e are committed to benefiting PATIENTS We promote only within the terms of the marketing authorisation. and ensuring patient safety by operating in a We do not advertise prescription only medicines to the public (other than vaccination professional, ethical and transparent manner campaigns approved by the health ministers). to ensure the appropriate and rational use of While our activities can encourage members of the public to seek treatment, they must medicines and to support the provision of high not promote the use of a specific prescription only medicine. quality healthcare. All interactions with patients and other stakeholders must comply with all We ensure that all information is accurate, fair and balanced. applicable laws and regulations. We act promptly when advised of adverse events and encourage the use of the MHRA Yellow Card Scheme to support patient safety. 2. W  e act with INTEGRITY and commit to engaging We are accountable for the activities of both our staff and third party providers. in relationships which are responsible, professional, We do not offer any improper payments, benefits, inducements, or anything of value ethical and transparent. We ensure that all our to influence actions or decisions, obtain or retain business, or otherwise secure any communications are appropriate, accurate, improper advantage, either directly or indirectly, to any individual, organisation factual, fair, balanced, up-to-date, not misleading, or stakeholder. capable of substantiation and reflect the available evidence, and that all other activities are appropriate and reasonable and of the highest standards. 3. W  e are committed to ensuring that We disclose certain transfers of value to health professionals, other relevant decision TRANSPARENCY is respected. We are open makers, healthcare organisations, institutions etc and payments made to patient about our activities and interactions with all organisations and the public, including patients and journalists. stakeholders and encourage our stakeholders to We publish details of ongoing and completed clinical trials via relevant databases act with the same openness. and registries. We do not disguise promotion. Company involvement in all materials and activities is made clear from the outset. 4. We interact with all our stakeholders with We recognise and seek to balance the needs of patients, health professionals and the RESPECT. We are committed to approaching our public, taking into account the environment within which the industry operates and the stakeholders in an open and constructive manner statutory controls governing medicines. and with mutual respect. We value the importance of independent decision-making by all those we interact with. 05  ABPI CODE OF PRACTICE FOR THE PHARMACEUTICAL INDUSTRY INTRODUCTION Promoting Appropriate Use of Medicines and seeks to achieve a balance between the needs of patients, The pharmaceutical industry in the United Kingdom is committed health professionals and the public, bearing in mind the political to benefiting patients by operating in a professional, ethical and and social environment within which the industry operates and transparent manner to ensure the appropriate use of medicines and the statutory controls governing medicines. The availability support the provision of high quality healthcare. This commitment of accurate, up-to-date information is vital to the safety of applies to all with whom the industry interacts. To demonstrate this patients and the appropriate use of medicines. Pharmaceutical commitment over 60 years ago, in October 1958, the Association companies must ensure that enquiries about their medicines are of the British Pharmaceutical Industry (ABPI), which represents the answered appropriately in a timely manner. UK industry, decided that certain activities should be covered in Strong support is given to the Code by the industry with all detail and thus agreed the first ABPI Code of Practice. The Code companies devoting considerable resources to ensure that their covers the promotion of medicines for prescribing to both health activities comply with it. Any complaint made against a company professionals and other relevant decision makers. It also includes under the Code is regarded as a serious matter both by that requirements for interactions with health professionals. In addition, company and by the industry as a whole. Sanctions are applied it sets standards for the provision of information about prescription against a company ruled in breach of the Code. only medicines to the public and patients, including patient organisations. Companies must ensure that all relevant personnel are appropriately trained in the requirements of the Code and must In addition to the Code, there is extensive UK and European have robust operating procedures under which all materials and law relating to the promotion of medicines. Following the UK activities covered by the Code are reviewed to ensure compliance departure from the EU, certain European law still applies in the both with the Code and with the appropriate legal requirements. UK, for example, in Northern Ireland. The Code reflects and extends beyond the relevant UK law. The Code incorporates the principles set out in: The aim of the Code is to ensure that the promotion of medicines the International Federation of Pharmaceutical Manufacturers to health professionals and other relevant decision makers is and Associations' (IFPMA) Code of Practice carried out within a robust framework to support high quality the European Federation of Pharmaceutical Industries and patient care. As well as covering promotional material, it controls Associations' (EFPIA) Code of Practice samples, meetings, promotional aids, outcome or risk sharing the World Health Organisation's Ethical Criteria for Medicinal agreements, patient access schemes, collaborative working Drug Promotion between the industry and healthcare organisations, including Directive 2001/83/EC on the Community Code relating to joint working between the pharmaceutical industry and the NHS, medicinal products for human use, as amended by Directive the conduct of non-interventional studies, the use of health 2004/27/EC professionals and other relevant decision makers as consultants and transfers of value to health professionals, other relevant the Human Medicines Regulations 2012 (2012 No. 1916), decision makers and healthcare organisations. The Code also as amended. sets standards relating to the provision of information to patients The Code covers the industry's activities only. However, those and the public as well as relationships with patient organisations. interacting with industry as individuals or organisations also The industry considers that provided the requirements of the have a responsibility to ensure that their interactions comply with Code are met, working with patients and patient organisations relevant legal requirements and are asked to follow the Code can bring significant public health benefits. These requirements where relevant and not make requests that are not in accordance also apply to working with all user groups, such as disability with the Code. Most of those interacting with the industry, associations, relative and carer associations and consumer other than patients, are covered by a selection of professional associations. There are disclosure requirements for interactions codes and guidance. For example, the General Medical Council with patient organisations and contracted services by patient Ethics guidance for doctors, the General Pharmaceutical organisations and individuals representing patient organisations Council's Standards for pharmacy professionals and the Nursing and certain contracted services provided by members of the & Midwifery Council's professional standards of practice and public, including patients and journalists. behaviour for nurses and midwives. In summary, companies must ensure that their materials are In a joint statement, the chief executives of statutory regulators of appropriate, factual, fair and capable of substantiation and that health and care professionals (which refers to individuals regulated all other activities are appropriate and reasonable. by one of nine regulators overseen by the Professional Standards Authority, including those referred to above) expect health and Ensuring High Standards social care professionals to 'Ensure their professional judgement The detailed provisions in the Code are to ensure that is not compromised by personal, financial or commercial interests, pharmaceutical companies operate in a responsible, ethical and incentives, targets or similar measures' and to 'Refuse all but the professional manner. Whilst the industry has a legitimate right to most trivial gifts, favours or hospitality, if accepting them could be promote medicines to health professionals, the Code recognises 06 CODE OF PRACTICE interpreted as an attempt to gain preferential treatment or would The PMCPA also provides informal guidance about the Code and contravene your professional code of practice'. its operation. Patient organisations are likely to be covered by Charity Commission Promoting Health rules as well as their own codes. The pharmaceutical industry takes The commitment of the pharmaceutical industry to bringing high note of all relevant codes and guidance as well as the ABPI Code. quality and effective medicines and vaccines to patients supports the UK's health and economy. Transparency The industry recognises that transparency is an important means Pharmaceutical companies invest over £4.5bn a year in researching of building and maintaining confidence. The operation of the and developing new products, for the benefit of patients. Code, including the complaints procedure, is a demonstration of the industry's commitment to transparency as are the requirement The Association of the British Pharmaceutical to declare pharmaceutical company involvement in activities Industry and its Code of Practice and materials and the publication of detailed reports of cases The Association of the British Pharmaceutical Industry exists to considered under the Code. The industry's global agreement make the UK the best place in the world to research, develop and to disclose certain clinical trial data is another example of the use new medicines. It represents companies of all sizes which industry's commitment to transparency. Companies also have invest in discovering the medicines of the future. to publish the summary details and results of non-interventional The ABPI represents companies which supply more than 80% of studies as well as the monetary value of certain support to all branded medicines used by the NHS and are researching and patient organisations. developing the majority of the current medicines pipeline. Other transparency changes, effective in 2012 and 2013, included The Code has been regularly revised since its inception in disclosure of the total amount of fees paid to consultants 1958 and is drawn up in consultation with the British Medical for certain services and the total amounts paid to sponsor Association, the Royal Pharmaceutical Society, the Royal College attendance at meetings organised by third parties. As set out of Nursing, the Medicines and Healthcare products Regulatory in the 2014 Code, starting in 2015 transparency was extended in Agency of the Department of Health, the Competition and relation to disclosure of fees and sponsorship provided to health Markets Authority and the Serious Fraud Office. Anyone is professionals, other relevant decision makers and healthcare welcome to send suggestions for amendments or additions organisations, including naming the recipients in many instances. to the Code to the PMCPA. The Code requires disclosure of donations, grants and It is a condition of membership of the ABPI to abide by the sponsorship to patient organisations and when contracting Code in both the spirit and the letter. The Code applies to both with patient organisations or individuals representing patient members and affiliate members of the ABPI. Companies which organisations to provide services for companies. Certain are not members of the ABPI may give their formal agreement to contracted services provided by the public, including patients and abide by the Code and accept the jurisdiction of the PMCPA, and journalists, will also now be disclosed on an annual basis; this will over sixty have done so. Thus the Code is accepted by virtually all start with 2022 data to be disclosed by 30 June 2023. pharmaceutical companies operating in the UK. Sanctions In each case where a breach of the Code is ruled, the company Administering the Code of Practice The Code is administered by the PMCPA, which is responsible concerned must give an undertaking that the practice in question for the provision of advice, guidance and training on the Code has ceased forthwith and that all possible steps have been taken as well as for the complaints procedure. The PMCPA operates to avoid a similar breach in the future. An undertaking must be independently of the ABPI itself. The relationship between the accompanied by details of the action taken to implement the ruling. PMCPA and the ABPI is set out in a protocol of agreement. At the conclusion of a case, a detailed case report is published. Financial information about the PMCPA is published in its Additional sanctions are imposed in serious cases. These can include: annual report. the audit of a company's procedures to comply with the Code, PMCPA publications can all be found on its website, followed by the possibility of a requirement for the pre-vetting www.pmcpa.org.uk, or are supplied on request. of future material Complaints under the Code are considered by the Code of recovery of material from those to whom it has been given Practice Panel and, where required, by the Code of Practice the issue of a corrective statement Appeal Board. Reports on completed cases are published by a public reprimand the PMCPA on its website. The PMCPA also publishes a list of advertising in the medical, pharmaceutical and nursing press of ongoing cases on its website. brief details of cases in which companies were ruled in breach of Clause 2 of the Code, were required to issue a corrective How to Complain statement or were the subject of a public reprimand Complaints should be submitted to the Director of the Prescription Medicines Code of Practice Authority, 7th Floor, Southside, 105 suspension or expulsion from the ABPI. Victoria Street, London, SW1E 6QT, telephone: 020 7747 8880, Monitoring of Activities and Guidance email: [email protected]. The Prescription Medicines Code of Practice Authority (PMCPA) arranges for advertising and meetings to be regularly monitored. CODE OF PRACTICE 07  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 Overarching Requirements CLAUSE 1 SCOPE OF THE CODE AND DEFINITION OF CERTAIN TERMS Clause 1 1.6 (24.1 SI) 'Europe' comprises those countries that are within Scope of the Code and Definition of Certain Terms the European Union and other countries with a trade association that is a member of the European Federation 1.1 (1.1) This Code applies to the promotion of medicines to of Pharmaceutical Industries and Associations (EFPIA). members of the United Kingdom (UK) health professions and to other relevant decision makers. For the purposes of 1.7 'Events' includes all professional, promotional, scientific the application of the Code, the UK includes the Channel and educational meetings, congresses, conferences, Islands and the Isle of Man. The Code also applies to a symposia, and other similar events (including, but not number of areas which are non-promotional, including limited to, advisory board meetings, visits to research information made available to the public about prescription or manufacturing facilities, and planning, training only medicines. It does not apply to the promotion of or investigator meetings for clinical trials and non- over-the-counter (OTC) medicines to members of the interventional studies) organised or sponsored by or on health professions when the object of that promotion is to behalf of a company (further examples can be found in encourage their purchase by members of the public. the supplementary information to Clause 10.1). 1.2 (28.2) Information or promotional material about medicines 1.8 (1.9) 'Healthcare organisation' means either a healthcare, which is placed on the internet outside the UK will be medical or scientific association or organisation such as regarded as coming within the scope of the Code, if it was a hospital, clinic, foundation, university or other teaching placed there by: institution or learned society whose business address, place of incorporation or primary place of operation is in Europe a UK company/with a UK company's authority, or or an organisation through which one or more health an affiliate of a UK company, or with the authority of professionals or other relevant decision makers such a company, and it makes specific reference to the provide services. availability or use of the medicine in the UK. If a healthcare organisation consists of only one health 1.3 'Collaborative working' refers to pharmaceutical companies professional or other relevant decision maker, then it would working with other organisations to deliver initiatives which be subject to the requirements in the Code regarding either enhance patient care or are for the benefit of patients individual health professionals. or alternatively benefit the National Health Service (NHS) and, as a minimum, maintain patient care. Further details 1.9 (1.4) 'Health professional' includes any member of the are given in Clause 20. medical, dental, pharmacy or nursing profession and any other person who in the course of their professional 1.4 'Contribution to costs related to events' in relation to activities may administer, prescribe, purchase, recommend the disclosure of transfers of value means providing or or supply a medicine. In relation to the annual disclosure covering the costs of travel, accommodation and/or of transfers of value (Clause 28), the term also includes any registration fees to support the attendance of an individual employee of a pharmaceutical company whose primary to an event organised or created by a company and/or occupation is that of a practising health professional. independent organisation. When providing sponsorship of events/meetings to organisations, associations etc such 1.10 'Hospitality' is limited to travel, subsistence (food and drink), contributions may include costs for subsistence (food accommodation and genuine registration fees extended in and drink). connection with events/meetings. 1.5 'Donations and grants' collectively mean providing funds, 1.11 (1.3) 'Medicine' means any branded or unbranded benefits-in-kind or services freely given for the purpose of medicine intended for use in humans which requires supporting healthcare, scientific research or education, with a marketing authorisation. no consequent obligation on the recipient organisation, institution and the like to provide goods or services to 1.12 (13.2) 'Non-interventional study' is defined as a study of a the benefit of the pharmaceutical company in return. marketed medicine where the medicine is prescribed in the Donations and grants to individuals are prohibited. usual manner in accordance with the terms of its marketing authorisation. The assignment of the patient to a particular In general, donations are physical items, services or benefits- therapeutic strategy is not decided by a study protocol in-kind which may be offered or requested. Grants are the but falls within current practice, and the prescription of provision of funds. the medicine is clearly separated from the decision to include the patient in the study. No additional diagnostic or monitoring procedures are applied to the patients, and epidemiological methods are used for the analysis of collected data. 08 CODE OF PRACTICE – CLAUSES 1–10 Clause numbers in brackets refer to the 2019 Code of Practice.  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 1.13 (1.5) 'Other relevant decision maker' particularly includes information supplied by pharmaceutical companies someone with an NHS role who could influence in any way to national public organisations such as the National the administration, consumption, prescription, purchase, Institute for Health and Care Excellence (NICE), the All recommendation, sale, supply or use of any medicine but Wales Medicines Strategy Group (AWMSG) and the who is not a health professional. Scottish Medicines Consortium (SMC) is exempt from the Code provided the information is factual, accurate and 1.14 (1.6) 'Over-the-counter medicine' (OTC) means a medicine not misleading or particular pack of medicine which is primarily advertised measures or trade practices relating to prices, margins to the public for use in self-medication. or discounts which were in regular use by a significant 1.15 (27.1) 'Patient organisation' means an organisation proportion of the pharmaceutical industry on mainly comprising of patients and/or caregivers or any 1 January 1993 user organisation such as a disability organisation, carer summaries of product characteristics or relative organisation and consumer organisation that European public assessment reports represents and/or supports the needs of patients UK public assessment reports and/or caregivers. risk minimisation material approved by the Medicines 1.16 'Individuals representing patient organisations' means a and Healthcare products Regulatory Agency (MHRA) person who is mandated to represent and express the views the labelling on medicines and accompanying package of a patient organisation. leaflets insofar as they are not promotional for the medicines concerned; the contents of labels and package 1.17 (1.2) 'Promotion' means any activity undertaken by a leaflets are covered by regulations pharmaceutical company or with its authority which promotes the administration, consumption, prescription, purchase, information relating to human health or diseases provided recommendation, sale, supply or use of its medicines. there is no direct or indirect reference to specific medicines. It includes: 1.18 (1.8) 'Promotional aid' means a non-monetary item given for a promotional purpose. Promotional aids may be given to journal and direct mail advertising health professionals and other relevant decision makers only the activities of representatives, including any electronic in accordance with Clause 10.4. Health professionals may, or printed material used by them however, be provided with items which are to be passed on the supply of samples to patients in accordance with Clause 19.2. the provision of inducements to prescribe, supply, 1.19 (1.7) 'Representative' means a representative calling on administer, recommend, buy or sell medicines by the members of the health professions and other relevant gift, offer or promise of any benefit or bonus, whether in decision makers in relation to the promotion of medicines. money or in-kind the provision of hospitality for promotional purposes 1.20 (23.2 SI) 'Research and development transfers of value' the sponsorship of promotional events/meetings means, for the purposes of disclosure, transfers of value to health professionals or healthcare organisations related to the sponsorship of scientific events/meetings, including the planning or conduct of: payment of travelling and accommodation expenses in connection therewith i. non-clinical studies (as defined in the OECD Principles on Good Laboratory Practice) all other promotion. ii. clinical trials (as defined in Regulation 536/2014) It does not include: iii. non-interventional studies that are prospective in nature replies made in response to unsolicited individual enquiries and that involve the collection of patient data from or from members of the health professions or other relevant on behalf of individual or groups of health professionals decision makers or in response to specific communications specifically for the study. from them whether of enquiry or comment, including letters published in professional journals, but only if they 1.21 (17 SI) 'Sample' means a small supply of a medicine relate solely to the subject matter of the letter or enquiry, provided to health professionals so that they may familiarise are accurate and do not mislead and are not promotional themselves with it and acquire experience in dealing with in nature it. A sample of a medicine may be provided only to a health professional qualified to prescribe that particular medicine. factual, accurate, informative announcements and reference material concerning licensed medicines and 1.22 A company can provide sponsorship for an activity to relating, for example, to pack changes, adverse reaction certain organisations. 'Sponsorship' means a contribution, warnings, trade catalogues and price lists, provided they financial or otherwise, in whole or in part provided by or include no product claims on behalf of a company, towards an activity (including an price lists relating to unlicensed medicines, provided they event/meeting or material) performed, organised, created include no product claims and they make clear that the etc by a healthcare organisation, patient organisation or products are unlicensed other independent organisation. Clause numbers in brackets refer to the 2019 Code of Practice. CLAUSES 1–10 – CODE OF PRACTICE 09  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 1.23 A company can provide support for individual health professionals or other relevant decision makers to attend The Code does not apply to the promotion of over-the-counter events/meetings. 'Support' in this context is the provision (OTC) medicines to members of the health professions when of a financial contribution, in whole or in part, whether paid the object of that promotion is to encourage their purchase directly or indirectly to individual health professionals or by members of the public as specified in Clause 1.1. Thus, for other relevant decision makers to attend events/meetings. example, an advertisement to doctors for an OTC medicine does not come within the scope of the Code if its purpose 1.24 'Third party' means a legal person/entity or individual that is to encourage doctors to recommend the purchase of the represents a company or interacts with other parties on medicine by patients. Where the advertisement is designed behalf of a company or relating to a company's medicine, to encourage doctors to prescribe the medicine, then it comes such as distributors, wholesalers, consultants, contract within the scope of the Code. research organisations, professional congress organisers, contracted sales forces, market research companies, Advertisements for OTC medicines to pharmacists are outside advertising agencies, media buyers, providers of services the scope of the Code. Advertisements to pharmacists for related to events, public relations services, non-clinical other medicines come within the scope of the Code. services, non-interventional studies management services etc. Companies should be aware that if a non-promotional item is used for a promotional purpose, it would come within Companies are responsible under the Code for the acts and the definition of promotion. If an item which is covered by omissions of their third parties which come within the scope regulations such as the summary of product characteristics of the Code, even if they act contrary to the instructions (SPC) or a patient information leaflet which is included in which they have been given. the pack (PIL) (excluded from the definition of promotion in 1.25 (1.10) 'Transfer of value' means a direct or indirect transfer of Clause 1.17) is used for a promotional purpose, then it would value, whether in cash, in-kind or otherwise, made, whether come within the scope of the Code. for promotional purposes or otherwise, in connection with Clause 1.1 Journals with an International Distribution the development or sale of medicines. A direct transfer of The Code applies to the advertising of medicines in value is one made directly by a company for the benefit of professional journals which are produced in the UK and/or a recipient. An indirect transfer of value is one made on intended for a UK audience. The identification of the country behalf of a company for the benefit of a recipient or in which a journal is 'produced' is based on factors such as through an intermediate and where the company knows where it is compiled and edited, and for printed journals, or can identify the recipient that will benefit from the where it is typeset, printed and bound, rather than on factors transfer of value. such as the location of the head office of the publisher. The following are not transfers of value for the purposes of the Code: International journals which are produced in English in the UK are subject to the Code even if only a small transfers of value that are solely related to OTC medicines proportion of their circulation is to a UK audience. ordinary course purchases and sales of medicines by It is helpful in these circumstances to indicate that the and between a company and a health professional or information in the advertisement is consistent with the a healthcare organisation UK marketing authorisation. samples of medicines provided in accordance with Clause 21 It should be noted that the Medicines and Healthcare transfers of value provided in accordance with Clauses products Regulatory Agency's (MHRA's) guidance 10.4, 10.5 and 19.2 'Advertising and Promotion of Medicines in the UK', The Blue subsistence provided to health professionals and other Guide, differs from the above by advising that advertising relevant decision makers in accordance with Clause 10.1. material in professional journals intended primarily for circulation in the UK, whether or not in the English language, must comply with UK legislation and with the UK marketing authorisation for the product. Clause 1 Supplementary Information In addition, where a journal is produced in the UK but intended for distribution solely to overseas countries, local Clause 1.1 Scope of the Code requirements and/or the requirements of the International The Code applies to the promotion of medicines to members Federation of Pharmaceutical Manufacturers and Associations' of the health professions and to other relevant decision (IFPMA) Code of Practice should be borne in mind. makers as specified in Clause 1.1. This includes promotion at events/meetings for UK residents held outside the UK. It Clause 1.1 Advertising to the Public and Advertising OTC also applies to promotion to UK health professionals and Medicines to Health Professionals other relevant decision makers at international events/ The promotion of medicines to the public for self-medication meetings held outside the UK, except that the promotional is covered by the Consumer Code of the Proprietary material distributed at such events/meetings will need to Association of Great Britain (PAGB) (www.pagb.co.uk). comply with local requirements. Information on applicability The PAGB also has a Professional Code which applies to of codes can be found in the supplementary information to advertising involving OTC medicines aimed wholly or mainly Clause 3.4. at persons qualified to prescribe or supply and people 10 CODE OF PRACTICE – CLAUSES 1–10 Clause numbers in brackets refer to the 2019 Code of Practice.  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 working for them, where the object of the advertising is to Clause 1.17 (1.2) Terms of Trade influence sales and/or recommendations to the public. See supplementary information to Clause 19.1. Clause 1.1 Promotion to Other Relevant Decision Makers Clause 1.17 (1.2) Price Lists for Unlicensed Medicines Particular attention is drawn to Clause 5.6. Price lists for unlicensed medicines which include no product claims and make clear that the products are unlicensed can Clause 1.17 (1.2) Replies Intended for Use in Response to be sent to health professionals and other relevant decision Individual Enquiries makers at reasonable intervals or in response to enquiries. An unsolicited enquiry is one without any prompting from They must not be used proactively in a manner which could the company. In answering any unsolicited enquiry, a be seen to be promoting unlicensed medicines, such as by company can offer to provide further information. If the displaying them on exhibition stands. enquirer subsequently requests additional information, this can be provided and would be exempt from the Code as Clause 1.17 (1.2) Risk Minimisation Plans and Material long as the additional information met the requirements of As part of the marketing authorisation process, the exemption. A solicited enquiry would be one where a companies can be required to have risk minimisation company invites or prompts a person to make a request. plans and material approved by the MHRA as part of the For example, material offering further information to readers company's pharmacovigilance obligations. Such approved would be soliciting a request for that information and documentation can be delivered by a representative or placing documents on exhibition stands amounts to an included on a company website without being considered to invitation to take them; neither can take the benefit of be promotion of the medicine to which it refers. this exemption. Replies intended for use in response to enquiries which are received on a regular basis may be drafted in advance provided that they are used only when they directly and solely relate to the particular enquiry. Documents must not look like promotional material. Overarching Requirements CLAUSES 2-4 OBLIGATIONS AND RESPONSIBILITIES Clause 2 Clause 3 Upholding Confidence in the Industry Obligations Activities or materials must never be such as to bring discredit 3.1 (3.1) A medicine must not be promoted prior to the grant of upon, or reduce confidence in, the pharmaceutical industry. the marketing authorisation which permits its sale or supply. 3.2 (26.1) Prescription only medicines must not be advertised to Clause 2 Supplementary Information the public. This prohibition does not apply to vaccination and other campaigns carried out by companies and A ruling of a breach of this clause is a sign of particular approved by the health ministers. censure and is reserved for such circumstances. 3.3 (29) When an undertaking has been given in relation to a Examples of activities that are likely to be in breach of ruling under the Code, the company concerned must ensure Clause 2 include prejudicing patient safety and/or public that it complies with that undertaking. health, excessive hospitality, inducements to prescribe, unacceptable payments, inadequate action leading to a 3.4 (1.11) Companies must comply with all applicable codes, breach of undertaking, promotion prior to the grant of a laws and regulations to which they are subject. marketing authorisation, conduct of company employees/ 3.5 Gifts for personal benefit (such as sporting or agents that falls short of competent care and multiple/ entertainment tickets, social courtesy gifts) are prohibited cumulative breaches of a similar and serious nature in the and must not be given, either directly or indirectly, to any same therapeutic area within a short period of time. individual health professional, other relevant decision maker or individual associated with a healthcare organisation or patient organisation. Providing or offering cash, cash equivalents or the provision of services that confer a personal benefit to the recipient is prohibited. Clause numbers in brackets refer to the 2019 Code of Practice. CLAUSES 1–10 – CODE OF PRACTICE 11  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 3.6 (12.1) Materials and activities must not be disguised promotion. The information provided must not: 3.7 (1.12) Each company must appoint a senior employee to vi. be promotional in style – product logos should be be responsible for ensuring that the company meets the avoided but company logos may be used; the brand requirements of the Code. name of the product may be included in moderation but it should not be stylised or used to excess Clause 3 Supplementary Information vii. include mock up drafts of either summaries of product characteristics or package leaflets. Clause 3.1 (3) Marketing Authorisation If requested, further information may be supplied or The legitimate exchange of medical and scientific a presentation made. information during the development of a medicine is not prohibited, provided that any such information or activity Clauses 3.1 and 3.2 (New) Temporary Authorisation for does not constitute promotion which is prohibited under this Sale or Supply without a Marketing Authorisation or any other clause. In response to certain types of public health emergency, under UK law, the licensing authority may temporarily authorise Clause 3.1 (3.1) Advance Notification of New Products the sale or supply of a medicine without a marketing or Product Changes Which May Significantly Affect authorisation. This might apply to medicines without Expenditure UK marketing authorisations or indications without UK NHS organisations and others involved in the purchase of marketing authorisations. The campaign must be approved medicines need to estimate their likely budgets in advance, by the health ministers and all other relevant requirements so there is a need for them to receive advance information of the Code will apply. In relation to advertising to health about the introduction of new medicines or changes to professionals and other relevant decision makers, further existing medicines which may significantly affect their information is given in Clause 11.3 and its supplementary level of expenditure, including that which might arise from information. In relation to advertising to the public, further changes in the patient pathway and/or service delivery. information is given in Clause 26.1 and its supplementary information. Companies should contact the Medicines When this information is required, the medicines concerned and Healthcare products Regulatory Agency (MHRA) for (or the changes to them) will not be the subject of information regarding approval of materials and activities. marketing authorisations (although applications will often have been made) and it would be in breach of the Code Clause 3.2 (26.1) Advertising of Medicines to the Public for them to be promoted. Companies wishing to provide The advertising of prescription only medicines to the advance notification must ensure that information is also public is also prohibited by the relevant regulations provided wherever possible for inclusion in national horizon relating to advertising. scanning databases. Non-promotional information can be provided as advance notification, but it must: The promotion of over-the-counter (OTC) medicines to the public for self-medication purposes is covered by the i. relate to a product which: Consumer Code of the Proprietary Association of Great contains a new active substance, or Britain (PAGB). contains an active substance prepared in a new way, Clause 3.4 (1.11) Applicability of Codes such as by the use of biotechnology, or Compliance with all applicable codes, laws and regulations is to have a significant addition to the existing range to which a pharmaceutical company is subject is particularly of authorised indications, or relevant when activities/materials involve more than one is to have a novel and innovative means country or when a company based in one country is of administration involved in activities in another country. ii. only be directed to those responsible for making policy Activities carried out and materials used by a decisions on budgets and not those only expected pharmaceutical company located in a European country to prescribe must comply with the national code of that European iii. state whether or not a new medicine or a change country as well as the national code of the country in which to an existing medicine is the subject of a UK the activities take place or the materials are used. marketing authorisation iv. state the likely cost or savings and budgetary Activities carried out and materials used in a European implications which must be such that they will country by a pharmaceutical company located in a country significantly change the organisation's likely expenditure other than a European country must comply with the (the budgetary implication might include the need for European Federation of Pharmaceutical Industries and service redesign) Associations (EFPIA) Code as well as the national code of the country in which the activities are carried out and v. be factual and limited to that sufficient to provide materials are used. For example, a company located in an adequate but succinct account of the product's the UK carrying out an activity outside the UK but within properties; other products should only be mentioned Europe, such as in France, must comply with the UK Code to put the new product or indication into context in the and the French Code regardless of whether or not UK therapeutic area concerned. 12 CODE OF PRACTICE – CLAUSES 1–10 Clause numbers in brackets refer to the 2019 Code of Practice.  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 4.4 (27.7 and 27.8) Companies must document and publicly health professionals or other relevant decision makers are disclose annually donations and grants whether financial, involved. Conversely, a company located in France carrying non-financial or a benefit-in-kind, and sponsorship (including out an activity in the UK must comply with the ABPI Code in relation to events/meetings) made to patient organisations. regardless of whether or not UK health professionals or other relevant decision makers are involved. Details of the various Fees and expenses for the provision of contracted services, codes can be found at www.efpia.eu or www.ifpma.org. including those performed by individuals representing patient organisations, which should be paid to patient The term 'company' means any legal entity that organises organisations must also be publicly disclosed annually as set or sponsors promotion which takes place within Europe, out in Clause 29. whether such entity be a parent company (eg the headquarters, principal office, or controlling company of a 4.5 (New Clause) Companies must document and publicly commercial enterprise), subsidiary company or any other disclose annually fees and expenses made to individual form of enterprise or organisation. members of the public, including patients and journalists, for the provision of contracted services performed as set out in In the event of a conflict of requirements, the more restrictive Clause 30. requirements would apply. There is a potential exception with regard to the limits for subsistence set in European 4.6 (13.1) Companies must disclose details of clinical trials in countries where the national association is a member of accordance with the Joint Position on the Disclosure of EFPIA and thus covered by the EFPIA Code as referred to in Clinical Trial Information via Clinical Trial Registries and the supplementary information to Clause 10.7. Databases and the Joint Position on the Publication of Clinical Trial Results in the Scientific Literature. Companies All international events, that is to say events that take place must include on the home page of their website information outside the responsible pharmaceutical company's home as to where details of their clinical trials can be found. country, must be notified in advance to any relevant local subsidiary or local advice taken. 4.7 (13.3) Companies must publish the summary details and results of non-interventional studies of marketed medicines Companies must take reasonable steps to ensure that any in a manner consistent with their parallel obligations with other parties that they commission to design, implement or respect to clinical trials. engage in activities covered by the Code but which do not act on behalf of the company, and are therefore not covered 4.8 (26.5) Companies are responsible for information about by Clause 1.17, for example, joint ventures or licensees, their products which is issued by their agencies, eg comply with the Code. communications, advertising etc. Clause 3.7 (1.12) Responsible Person There is an assumption that the responsible person is the Clause 4 Supplementary Information managing director or chief executive or equivalent unless other formal arrangements have been made within the company. Clauses 4.1 and 4.2 (25.1 and 25.2) Scientific Service Companies can have one scientific service in charge of both responsibilities or separate services with clearly delineated duties. Clause 4 Clause 4.6 (13.1) Details of Clinical Trials Responsibilities This clause requires the provision of details about ongoing clinical trials (which must be registered within 21 days of 4.1 (25.1) Companies must have a scientific service to compile initiation of patient enrolment) and the results of completed and collate all information received from any source about trials for medicines licensed for use and commercially the medicines which they market. available in at least one country. 4.2 (25.2) Companies must have a scientific service to deal with Further information can be found in the current Joint the approval and supervision of non-interventional studies. Position on the Disclosure of Clinical Trial Information via This scientific service must include a registered medical Clinical Trial Registries and Databases and the current Joint practitioner or a pharmacist registered in the UK who will be Position on the Publication of Clinical Trial Results in the responsible for the oversight of non-interventional studies Scientific Literature, both at www.ifpma.org/resource-centre/ (including the review of any responsibilities relating to such clinical-trials-position-papers/. studies, particularly those given to representatives) and certification of the protocol. Details about clinical trials must be limited to factual and non-promotional information. Such information must not 4.3 (24.1) Companies must document and publicly disclose constitute promotion to health professionals, other relevant certain transfers of value made directly or indirectly to decision makers or the public. health professionals, other relevant decision makers and healthcare organisations located in Europe as set out in Clause 28. This includes any employee of a pharmaceutical company whose primary occupation is that of a practising health professional. Clause numbers in brackets refer to the 2019 Code of Practice. CLAUSES 1–10 – CODE OF PRACTICE 13  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 Overarching Requirements CLAUSES 5-10 QUALITY STANDARDS Clause 5 These include: High Standards and Suitability the display of naked or partially naked people for the 5.1 (9.1) High standards must be maintained at all times. purpose of attracting attention to the material or the use of sexual imagery for that purpose 5.2 (9.2) All material and activities must recognise the special 'teaser' communication/advertising whereby material is nature of medicines and respect the professional standing intended to 'tease' the recipient by eliciting an interest in or otherwise of the audience to which they are directed and something which will be following or will be available at a must not be likely to cause offence. later date without providing any actual information about it. 5.3 (9.3) The name or photograph of a member of a health Care should be taken with language, use of abbreviations profession must not be used in any way that is contrary to etc and the use of emojis and the like. the conventions of that profession. Clause 5.5 (9.10) Declaration of Involvement 5.4 (9.7) Extremes of format, size or cost of material must be The wording of the declaration of involvement must be avoided. Informational or educational materials must be unambiguous so that readers are immediately able to inexpensive, directly relevant to the practice of medicine or understand the extent of the company's involvement and pharmacy and directly beneficial to the care of patients. influence. This is particularly important when companies are involved in the production of material which is circulated 5.5 (9.10) Material relating to medicines and their uses, whether by an otherwise wholly independent party, such as promotional or not, and information relating to human supplements to health professional journals. health or diseases which is sponsored by a pharmaceutical company or in which a pharmaceutical company has any The declaration of sponsorship must be sufficiently other involvement, must clearly indicate the role of that prominent to ensure that readers of sponsored material are pharmaceutical company. aware of it at the outset. The only exception to this is market research material if Clause 5.7 (28.6) Sites Linked via Company Sites it is such that the name of the company involved is not Sites linked via company sites are not necessarily covered by required to be stated; then the material must state that it is the Code. sponsored by a pharmaceutical company. 5.6 (11.1) Material should only be provided or made available to those groups of people whose need for or interest in it can reasonably be assumed. Material should be tailored to the Clause 6 audience to whom it is directed. Information, Claims, Comparisons and Disparagement 5.7 (28.6) It should be made clear when a user is leaving any Clauses 14 and 18 may also be relevant. of the company's websites or websites sponsored by the company or is being directed to a website which is not that 6.1 (7.2) Information, claims and comparisons must be accurate, of the company. balanced, fair, objective and unambiguous and must be based on an up-to-date evaluation of all the evidence and reflect that evidence clearly. They must not mislead either Clause 5 Supplementary Information directly or by implication, by distortion, exaggeration or undue emphasis. Clauses 5.1 and 5.2 (9.1 and 9.2) High Standards and Suitability Material must be sufficiently complete to enable recipients The special nature of medicines and the audience to which to form their own opinion of the therapeutic value of the information is directed require that the standards set for the medicine. information about medicines are higher than those which might be acceptable for general commodity communications 6.2 (7.4) Any information, claim or comparison must be capable and advertising. of substantiation. It follows, therefore, that certain types, styles and methods Companies must provide substantiation, following a request of communication, even where they might be acceptable for it as set out in Clauses 14.3 and 18.2. In addition, when for products other than medicines, are unacceptable. data from a clinical trial is used, companies must ensure that where necessary, that trial has been registered and the results disclosed in accordance with Clause 4.6. 14 CODE OF PRACTICE – CLAUSES 1–10 Clause numbers in brackets refer to the 2019 Code of Practice.  CONTENTS CLAUSES 1–10 CLAUSES 11–17 CLAUSES 18–22 CLAUSES 23–25 CLAUSES 26–27 CLAUSES 28–31 6.3 (7.8) All artwork, including illustrations, graphs and tables, must conform to the letter and spirit of the Code and, when economic evaluation of medicines. Any claim involving the taken from published studies, a reference must be given. economic evaluation of a medicine must be borne out by Graphs and tables must be presented in such a way as to the data available and not exaggerate its significance. To give a clear, fair, balanced view of the matters with which be acceptable as the basis of claims, the assumptions made they deal and must not be included unless they are relevant in an economic evaluation must be clinically appropriate to the claims or comparisons being made. and consistent with the marketing authorisation emerging clinical or scientific opinions which have 6.4 (7.9) Information and claims about adverse reactions must not been resolved in favour of one generally accepted reflect available evidence or be capable of substantiation viewpoint must be referred to in a balanced manner by clinical experience. It must not be stated that a product hanging comparisons whereby a medicine is described as has no adverse reactions, toxic hazards or risks of addiction being better or stronger or suchlike without stating that or dependency. The word 'safe' must not be used with which it is compared must not be made without qualification. price comparisons as with any comparison, must be 6.5 (7.11) The word 'new' must not be used to describe any accurate, fair and must not mislead. Valid comparisons product or presentation which has been generally available, can only be made where like is compared with like. It or any therapeutic indication which has been promoted, for follows, therefore, that a price comparison should be more than twelve months in the UK. made on the basis of the equivalent dosage requirement for the same indications 6.6 (8.1) The medicines, products and activities of other statistical information, claims and comparisons must pharmaceutical companies must not be disparaged. have a sound statistical basis. Differences which do not 6.7 (8.2) The health professions and the clinical and scientific reach statistical significance must not be presented in opinions of health professionals must not be disparaged. such a way as to mislead. Instances have occurred where claims have been based on published papers in which the arithmetic and/or statistical Clause 6 Supplementary Information methodology was incorrect. Accordingly, before statistical Clauses 14 and 18 may also be relevant. information is included in material, it must have been subjected to statistical appraisal. Clause 6.1 (7) General The application of this clause is not limited to information or Clause 6.3 (7.8) Artwork, Illustrations, Graphs and Tables claims of a medical or scientific nature. It includes, among Care must be taken to ensure that artwork does not mislead other things, information or claims relating to pricing and as to the nature of a medicine or any claim or comparison market share. and that it does not detract from any warnings or contra- indications. For example, anatomical drawings used to It should be borne in mind that claims in material must show results from a study must not exaggerate those results be capable of standing alone as regards accuracy etc. and depictions of children should not be used in relation to In general, claims should not be qualified by the use of products not authorised for use in children in any way which footnotes and the like. might encourage such use. Clause 6.1 (7.2) Information, Claims and Comparisons Particular care should be taken with graphs and tables The following are areas where particular care should be to ensure that they do not mislead, for example, by being taken by companies: incomplete or by the use of suppressed zeros or unusual claims for superior potency in relation to weight are scales. Differences which do not reach statistical significance generally meaningless and best avoided unless they can must not be presented in such a way as to mislead. be linked with some practical advantage, for example, reduction in adverse reactions or cost of effective dosage Graphs and tables must be adequately labelled so that the information presented can be readily understood. When data derived from in vitro studies, studies in healthy taken from published studies, the source of the artwork must volunteers and in animals must not be used in a way that be given (see also Clause 14.2). If a graph, table or suchlike is misleads as to its significance. The extrapolation of such taken from a published study, it must be faithfully reproduced data to the clinical situation should only be made where except where modification is needed in order to comply with there is data to