Standards for Commercial Support

Since its founding in 1981, the ACCME has been committed to continuously improving the quality, validity, and independence of CME in the United States. The 2004 ACCME Standards for Commercial SupportSM: Standards to Ensure Independence in CME Activities (Accreditation Criteria 7–10) are designed to make certain that CME activities are independent and free of commercial bias. The Standards impose stringent restrictions on CME providers’ interactions with drug/device companies and other companies the ACCME defines as a commercial interest. The ACCME allows providers to accept company funding for CME activities, but prohibits any commercial influence, direct or indirect, over CME content.

ACCME Standards for Commercial SupportSM: Standards to Ensure Independence in CME Activities: Building on guidelines that the ACCME first issued in 1987 and formally adopted in 1992, the 2004 ACCME Standards for Commercial Support comprise six Standards: Independence, Resolution of Personal Conflicts of Interest, Appropriate Use of Commercial Support, Appropriate Management of Associated Commercial Promotion, Content and Format without Commercial Bias, and Disclosures Relevant to Potential Commercial Bias.

Among other requirements, the Standards mandate the following:

• All those involved in the development and presentation of CME activities must disclose relevant financial relationships with commercial interests.
• CME planners, providers and faculty who refuse to disclose financial relationships are disqualified from planning or teaching CME activities.
• Accredited CME providers must implement strategies for identifying and resolving conflicts of interest.

When making decisions about implementing the ACCME Standards for Commercial Support, the ACCME says that CME providers must always defer to independence from commercial interests, transparency, and the separation of CME from product promotion. In other words, the purpose of CME must be to serve physicians’ learning and practice needs and to promote public health.

In addition to the Standards, the ACCME’s clinical content validation policy and policies supplementing the Standards for Commercial Support ensure the independence and validity of accredited CME.

A National Model

The Standards for Commercial Support are recognized as a national model by federal and state government agencies, other health care accrediting bodies, and the profession of medicine. The Standards been adopted by the Accreditation Council for Pharmacy Education and have been accepted by the American Academy of Family Physicians, the American Nurses Credentialing Center, the American Osteopathic Association, and the Association of Regulatory Boards of Optometry Committee on Optometric Practitioner Education. To address the challenges presented by the evolving health care environment, the ACCME participates in Standards for Commercial Support Users Group meetings, which bring together leadership organizations to discuss strategies for ensuring the independence of continuing education in health care and related fields.

The Council of Medical Specialty Societies Code for Interactions with Companies  includes a section on CME, which begins by stating: “Societies will comply with ACCME Standards for Commercial Support, including by adopting policies and procedures designed to identify and manage conflicts of interest in company-supported society CME programs.”

The Standards have been referenced in state legislation as the standard for independent CME. The Food and Drug Administration’s (FDA) Risk Evaluation and Mitigation Strategy (REMS)  for opioid medications includes accredited CME as a central component of the public health initiative. In its draft blueprint , the FDA recognized the importance of the Standards for Commercial Support in maintaining the independence of continuing education about the opioid REMS.

Representatives from industry have asked other health care professions to consider adopting the ACCME Standards to provide a basis for their interactions.

Additional Guidance

Since the release of the Standards for Commercial Support in 2004, the ACCME has worked closely with accredited providers and recognized accreditors as they have adapted their CME programs to comply. The ACCME and accredited providers have worked together to develop strategies that facilitate the appropriate free flow of new information and scientific exchange, while preserving accredited CME’s independence and freedom from commercial influence. The ACCME has provided additional guidance related to specific circumstances in response to questions and concerns expressed by accredited providers and other stakeholders.

One such circumstance is training about medical devices. The Food and Drug Administration sets training requirements for some medical equipment. To facilitate the fulfillment of these requirements and to support accredited providers’ commitment to offering high-quality, independent education about procedures using medical devices, the ACCME offered additional guidance to accredited providers about how to develop procedural CME that is compliant with the Standards for Commercial Support.

In 2010, the ACCME released additional guidance about the role of ACCME-defined commercial interest employees in accredited CME, which outlined the ACCME standards for ensuring independence for CME about discovery and research. This guidance was the result of the ACCME and accredited providers working together and recognizing that there are circumstances where an employee of an ACCME-defined commercial interest can make a scientific presentation within accredited CME about their company’s research and be compliant with the ACCME Standards for Commercial Support. The guidance includes examples of important factors for accredited providers and the ACCME to consider in determining an appropriate role for an employee of an ACCME-defined commercial interest in planning or presenting accredited CME. In response, the ACCME received the following statement:

“We applaud the Accreditation Council for Continuing Medical Education’s efforts to provide additional guidance for ensuring research independence and a free flow of scientific exchange, while safeguarding accredited CME from commercial influence. Your vigilance in this important matter contributes to the best practices of unbiased information-sharing and will benefit, ultimately, the health of the American public. "— Raynard S. Kington, MD, PhD, Deputy Director, National Institutes of Health

Related Information
ACCME at a Glance
ACCME 21st Century Milestones
News Release:  Accreditation Council for CME Plans to Assist Accredited Providers That Choose To Address Prescription Drug Abuse Through Accredited CME and FDA-defined REMS
News Release:  Accreditation Council for CME Supports CMSS Code for Interactions with Companies