4.1 The prescribing information listed in Clause 4.2 must be provided in a clear and legible manner in all promotional material for a medicine except for abbreviated advertisements (see Clause 5).
The prescribing information must be positioned for ease of reference and must not be presented in a manner such that the reader has to turn the material round in order to read it, for example by providing it diagonally or around the page borders.
The prescribing information must form part of the promotional material and must not be separate from it.
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Clause 4.1 Prescribing Information and Summaries of Product Characteristics
Each promotional item for a medicine must be able to stand alone. For example, when a ‘Dear Doctor’ letter on a medicine is sent in the same envelope as a brochure about the same medicine, each item has to include the prescribing information. It does not suffice to have the prescribing information on only one of the items. The inclusion of a separate summary of product characteristics is not sufficient to conform with the provisions of this clause.
There may be instances where reproducing the summary of product characteristics will not be an acceptable way to fulfil the requirement for prescribing information. For example, Clause 6.3 limits advertising in journals for a particular product to two pages.
The prescribing information must be consistent with the summary of product characteristics for the medicine.
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Clause 4.1 Legibility of Prescribing Information
The prescribing information is the essential information which must be provided in promotional material. It follows therefore that the information must be given in a clear and legible manner which assists readability.
Legibility is not simply a question of type size. The following recommendations will help to achieve clarity:
- type size should be such that a lower case ‘x’ is no less than 1 mm in height
- lines should be no more than 100 characters in length, including spaces
- sufficient space should be allowed between lines to facilitate easy reading
- a clear style of type should be used
- there should be adequate contrast between the colour of the text and the background
- dark print on a light background is preferable
- emboldening headings and starting each section on a new line aids legibility.
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Clauses 4.1 and 4.9 Date of Prescribing Information and Promotional Material
If the summary of product characteristics is not used then the date that the prescribing information was last drawn up or last revised must be included (Clause 4.2 viii).
In addition, promotional material (other than journal advertising) must include the date that the material as a whole, ie the copy plus the prescribing information, was drawn up or last revise
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Clause 4.1 Electronic Journals
The first part of an advertisement in an electronic journal, such as the banner, is often the only part of the advertisement that is seen by readers. It must therefore include a clear, prominent statement as to where the prescribing information can be found. This should be in the form of a direct link. The first part is often linked to other parts and in such circumstances the linked parts will be considered as one advertisement.
If the first part mentions the product name then this is the most prominent display of the brand name and the non-proprietary name of the medicine or a list of the active ingredients using approved names where such exist must appear immediately adjacent to the most prominent display of the brand name. The size must be such that the information is easily readable. If the product is one that is required to show an inverted black equilateral triangle on its promotional material then the black triangle symbol must also appear adjacent to the product name (see Clause 4.11). The size must be such that it is easily readable. The requirement of Clause 12.1 that promotional material and activities must not be disguised should also be borne in mind.
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Clause 4.1 Advertisements for Devices
Where an advertisement relates to the merits of a device used for administering medicines, such as an inhaler, which is supplied containing a variety of medicines, the prescribing information for one only need be given if the advertisement makes no reference to any particular medicine.
Full prescribing information must, however, be included in relation to each particular medicine which is referred to.
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Clause 4.1 Prescribing Information at Exhibitions
The prescribing information for medicines promoted on posters and exhibition panels at meetings must either be provided on the posters or panels themselves or must be available at the company stand. If the prescribing information is made available at the company stand, this should be referred to on the posters or panels.
4.2 The prescribing information consists of the following:
- the legal classification of the product
- the cost (excluding VAT) of either a specified package of the medicine to which the advertisement relates, or a specified quantity or recommended daily dose, calculated by reference to any specified package of the product, except in the case of advertisements in journals printed in the UK which have more than 15 per cent of their circulation outside the UK and audio-visual advertisements and prescribing information provided in association with them and
i) the name of the medicine (which may be either a brand name or a non-proprietary name)
ii) a quantitative list of the active ingredients, using approved names where such exist, or other non- proprietary names; alternatively, the non- proprietary name of the product if it is the subject of an accepted monograph
iii) at least one authorized indication for use consistent with the summary of product characteristics
iv) a succinct statement of the information in the summary of product characteristics relating to the dosage and method of use relevant to the indications quoted in the advertisement and, where not otherwise obvious, the route of administration
v) a succinct statement of common adverse reactions likely to be encountered in clinical practice, serious adverse reactions and precautions and contra-indications relevant to the indications in the advertisement, giving, in an abbreviated form, the substance of the relevant information in the summary of product characteristics, together with a statement that prescribers should consult the summary of product characteristics in relation to other adverse reactions
vi) any warning issued by the Medicines Commission, the Commission on Human Medicines, the Committee on Safety of Medicines or the licensing authority, which is required to be included in advertisements
vii) the number of the relevant marketing authorization and the name and address of the holder of the authorization, or the name and address of the part of the business responsible for its sale or supply
viii) the date the prescribing information was drawn up or last revised.
The summary of product characteristics may be provided instead of i-viii above.
If the summary of product characteristics is not used then the information specified above in relation to iv, v, and vi which is required to be included in advertisements, must be placed in such a position in the advertisement that its relationship to the claims and indications for the product can be appreciated by the reader
4.3 In addition, the non-proprietary name of the medicine or a list of the active ingredients using approved names where such exist must appear immediately adjacent to the most prominent display of the brand name in bold type of a size such that a lower case ‘x’ is no less than 2mm in height or in type of such a size that the non- proprietary name or list of active ingredients occupies a total area no less than that taken up by the brand name.
For electronic advertisements the non-proprietary name of the medicine or the list of active ingredients, as required by Clause 4.3, must appear immediately adjacent to the brand name at its first appearance in a size such that the information is readily readable.
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Clause 4.3 Non-Proprietary Name
‘Immediately adjacent to…’ means immediately before, immediately after, immediately above or immediately below.
It should be noted that in a promotional letter the most prominent display of the brand name will usually be that in the letter itself, rather than that in prescribing information provided on the reverse of the letter.
4.4 In the case of digital material such as advertisements in electronic journals, emails, electronic detail aids and such like, the prescribing information as required by Clause 4.1 may be provided either:
- by inclusion in the digital material itself or
- by way of a clear and prominent direct single click link.
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Clause 4.4 Use of Links for Prescribing Information
When digital material provides the reader with a link to prescribing information on another website then such a link should only be included for use when the material is generally expected to be viewed online, for example, advertisements in electronic journals or electronic detail aids when used remotely and the like. This is to ensure that at the time of reading the link is active and will provide readers with the necessary information. When material is more likely to be viewed offline, such as electronic detail aids to be used by representatives when visiting health professionals, emails and the like, then the requisite information must be provided as part of the item itself or as a link that does not require the reader to be online.
4.5 In the case of audio-visual material such as films, DVDs and suchlike and in the case of interactive data systems, the prescribing information may be provided either:
by way of a document which is made available to all persons to whom the material is shown or sent, or
by inclusion on the audio-visual recording or in the interactive data system itself.
When the prescribing information is included in an interactive data system instructions for accessing it must be clearly displayed.
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Clause 4.5 Prescribing Information on Audio-Visual Material
Where prescribing information is shown in the audio-visual material as part of the recording, it must be of sufficient clarity and duration so that it is easily readable. The prescribing information must be an integral part of the advertisement and must appear with it. It is not acceptable for the advertisement and the prescribing information to be separated by any other material.
4.6 In the case of promotional material included on the Internet, there must be a clear, prominent statement as to where the prescribing information can be found.
4.7 In the case of a printed journal advertisement where the prescribing information appears overleaf, at either the beginning or the end of the advertisement, a reference to where it can be found must appear on the outer page of the other page of the advertisement in a type size such that a lower case ‘x’ is no less than 2mm in height.
4.8 In the case of printed promotional material consisting of more than four pages, a clear reference must be given to where the prescribing information can be found.
4.9 Promotional material other than advertisements appearing in professional publications must include the date on which the promotional material was drawn up or last revised.
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Clause 4.9 Date Drawn Up or Last Revised
This is in addition to the requirement in Clause 4.2 that the date of the prescribing information be included.
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Clause 4.9 Dates on Loose Inserts
A loose insert is not regarded for this purpose as appearing in the professional publication with which it is sent and must therefore bear the date on which it was drawn up or last revised.
4.10 All promotional material must include the prominent statement ‘Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to [relevant pharmaceutical company]’.
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Clause 4.10 Adverse Event Reporting
A telephone number or email address for the relevant department of the company may be included. Text is more likely to be deemed to be prominent if it is presented in a larger type size than that used for the prescribing information.
In the event that the website address given in Clause 4.10 is changed by the Medicines and Healthcare Products Regulatory Agency, companies may use a statement incorporating the new address as soon as the change is made and must use the new address within one year of the change.
4.11 When required by the licensing authority, all promotional material must show an inverted black equilateral triangle to denote that additional monitoring is required in relation to adverse reactions.
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Clause 4.11 Black Triangle Symbol
The agreement between the then Committee on Safety of Medicines and the ABPI on the use of the black triangle is that:
The symbol should always be black and its size should normally be not less than 5mm per side but with a smaller size of 3mm per side for A5 size advertisements and a larger size of 7.5mm per side for A3 size advertisements:
- the symbol should appear once and be located adjacent to the most prominent display of the name of the product
- no written explanation of the symbol is necessary.
Digital communications are also covered by this requirement and the black triangle symbol should be located adjacent to the first mention of the product as this is likely to be considered the most prominent display of the name of the product. The size must be such that it is easily readable.
Summaries of product characteristics and package leaflets are excluded from the definition of ‘promotion’ in the Code by Clause 1.2. However it should be noted that EU legislation now requires the black triangle symbol to appear on summaries of product characteristics and on package leaflets. The size of the black triangle on these documents has to be proportionate to the font size of the subsequent text with a minimum length of 5mm per side. The EU requirements do not apply to promotional material. Obligatory explanatory wording is also required.
