Fidelity’s Tamiflu practice draws criticism

One of Boston’s biggest employers, Fidelity Investments, is offering workers just-in-case prescriptions for flu-fighting medication, a practice that has provoked the wrath of public health specialists concerned about overuse of such drugs.
Internal memos obtained by the Globe show the company is enlisting a private physicians group to evaluate workers and write prescriptions for the drug Tamiflu, which can shorten the severity and duration of influenza. The prescriptions are being filled by a mail-order pharmacy, and everything is paid for by Fidelity.
“Fidelity’s greatest concern is for the well-being of its employees,’’ one memo said. “Fidelity’s health and emergency preparedness experts believe it’s prudent to get the medication to employees as a precaution.’’
Public health authorities disagree.
Since it came to light last month that the big Boston law firm Ropes & Gray was offering healthy workers caches of Tamiflu, officials in Massachusetts and Rhode Island have condemned stockpiling of the drug.
People may confuse the common cold for the flu and inappropriately down a few Tamiflu capsules, they said, which over time can diminish the drug’s effectiveness against influenza by allowing the virus to become resistant to the medication. While that has yet to happen widely with swine flu, other strains of the disease have become broadly resistant to antiviral medications.
“The idea of employers stocking antivirals for the indiscriminate use of their employees runs counter to sound public health principles,’’ said Dr. Lauren Smith, medical director of the Massachusetts Department of Public Health. “That’s not how you’re going to keep your workforce healthy. That’s what I told Ropes & Gray: You should be sending your associates home when they’re sick.’’
In an e-mailed response to inquiries about Fidelity’s plans for Tamiflu, company spokesman Adam Banker said he was not at liberty to discuss internal policies governing employee health. Fidelity has about 31,000 workers nationwide, including 16,000 in New England.
“While we take the health and safety of Fidelity employees very seriously and our plans for helping protect employees and the firm are well developed, we are not going to discuss the details of our preparedness plans outside the company,’’ Banker said.
Authorities in Rhode Island, where Fidelity has a significant presence, feel so strongly about the issue of inappropriate Tamiflu prescribing that in an Oct. 26 memo to physicians, the state’s top health official warned that if he catches doctors writing injudicious prescriptions, he may turn them over to the Board of Medical Licensure and Discipline.
A spokeswoman for the Rhode Island Department of Health, Carol Hall-Walker, said Thursday she was not aware of any physicians reported for unwarranted Tamiflu prescribing.
“This is a small state. Believe it or not, we tend to hear from the community, from physicians, from pharmacists,’’ Hall-Walker said. “If we were seeing something that raised our eyebrows or that raised a question, we would follow up with the situation and the people involved and try to find out what’s happening.’’
According to the internal Fidelity memos, a company called Affiliated Physicians will evaluate Fidelity workers and “if based on your medical history [Affiliated] determines that Tamiflu is appropriate for you, they will prescribe the drug.’’ The screenings, according to a memo, will be conducted at Fidelity offices in Boston and elsewhere.
Affiliated is the same firm writing Tamiflu prescriptions for Ropes & Gray. An Affiliated executive did not return a telephone message yesterday seeking comment. But in an e-mail to the Globe last month, the physician group’s chief operating officer cited guidelines from the US Department of Health and Human Services that condone employer Tamiflu purchases for several reasons, including “to ensure early treatment to employees who become ill.’’
A representative of the federal agency said the guidelines do not sanction prescribing antivirals to healthy employees.
One of the Fidelity memos contains an admonition to employees: If you lose your supply of Tamiflu, you’re out of luck. Prescriptions will not be replaced.