LETTER OF AGREEMENT FOR FINANCIAL SUPPORT

This form must be completed by the organization providing financial support for the CME activity and signed by the Joint Provider Representative. The Joint Provider is responsible for submitting this to PAC/LAC.

PAC/LAC, as the accredited provider of continuing medical education, has the responsibility to assure that activities that are certified for credit meet the criteria and standards of the Accreditation Council for Continuing Medical Education (ACCME). Compliance with the standards for commercial support of continuing medical education (CME) is an integral part of the process. One of the key factors related to the use of commercial support is the execution of a Letter of Agreement between the accredited provider and the commercial interest (grantor) providing funding to support the activity. The purpose of this agreement is to document the independence of the accredited provider and joint-Provider from any influence of the commercial interest in the development and conduct of the educational activity and to establish the terms and conditions under which the education grant will be received.

This Letter of Agreement between PAC/LAC (accredited provider) and _

contains the purposes, terms and conditions for which an educational grant in support of a CME activity is made.

Name of CME Activity:
Date of CME Activity:
Joint Provider:
Organization:
Representative:
Address:
Tel. No.:
E-mail:

The organization wishes to provide the following educational support for the above named activity: (please check all that apply)

Unrestricted educational grant in the amount of: / $
Restricted grant to reimburse expenses for:
Faculty (list all):
All Expenses : / $ / Travel: / $ / Honorarium: / $
Support for Catering Function: / $
Other in-kind support (e.g. equipment loan, brochure distribution): / $
Please specify:
Advertisement or Exhibit: / $

LETTER OF AGREEMENT FOR FINANCIAL SUPPORT (cont’d)

TERMS AND CONDITIONS

  1. Statement of Purpose: Program is for scientific and educational purposes only and will not promote the commercial interests products, directly or indirectly.
  2. Control of Content & Selection of Presenters & Moderators: The commercial interest agrees not to attempt to direct the content of the program.
  3. Disclosure of Financial Relationships: Meaningful disclosures will be made to the audience, at the time of the program, of commercial support and any significant financial relationship between the accredited provider, joint-provider and the commercial interest or between individual speakers, moderators, planning committee, staff or authors and the commercial interest related to the content of the CME activity.
  4. Involvement in Content: There will be no “scripting”, emphasis, or direction of content by the commercial interest or its agents. There will be no content review by the commercial interest.
  5. Ancillary Promotional Activities: No promotional activities will be permitted in the same room as the CME activity. No product advertisements will be permitted in the activity room or in the activity syllabus.
  6. Objectivity & Balance: The accredited provider and the joint-provider will make every effort to assure that data regarding the commercial interest’s products or competing products are objectively selected and presented with favorable and unfavorable information and balanced discussion of prevailing information on the product(s) and/or alternative treatments based on scientific evidence.
  7. Limitations on Data: The accredited provider and joint-provider will assure, to the extent possible, meaningful disclosure of limitations on data, e.g. ongoing research, interim analysis, preliminary data or unsupported opinion.
  8. Discussion of “Off-Label” or Unapproved Uses: The accredited provider and joint-provider will require that presenters disclose to the provider when a product is not approved in the United States for the use under discussion and such information will be disclosed to the learner.
  9. Opportunities for Debate: The accredited provider and joint-provider will assure meaningful opportunities for questioning or scientific debate.
  10. Independence of Accredited Provider and Joint-Provider in use of Contributed Funds:
  11. Funds should be in the form of an educational grants made payable to PAC/LAC. PAC/LAC may delegate authority to manage funds to the joint-provider with the condition that they will abide by the terms and conditions.
  12. All other support associated with the CME activity (e.g. distributing brochures, in-kind donations, etc.) must be given with the full knowledge and approval of PAC/LAC.
  13. No other funds from the commercial interest will be paid to the program or course director, faculty, planning committee members or others involved with the CME activity (i.e. additional honoraria, extra social events, etc.).

The commercial interest agrees to abide by all requirements of the ACCME Standards for Commercial Support of Continuing Medical Education (appended) and all applicable laws.

The accredited provider and joint-Provider agree to abide by the ACCME Standards for Commercial Support for Continuing Medical Education; acknowledge commercial support in activity brochures, syllabi, and other materials; and upon request, furnish the commercial interest a report concerning the expenditure of funds provided.

______

Signature: Commercial Interest DateSignature: Joint Provider RepresentativeDate

______

Signature: Accredited ProviderDate

Rev. 9/2014