Government regulators have never watched pharma sales forces as closely as they do today. On top of familiar reporting requirements, such as how many samples were given to whom, federal regulators want to know what marketers were thinking. Why, they sometimes want to know, did a sales rep give one physician more samples than another one down the hall? If they want more specifics, they can even ask for a rep's call notes. And while the reps are keeping up with federal laws, they have to learn a new set of regulations for every state in their territory. In some states, for example, nurse practitioners can sign sample receipts, but in others, doctors must sign personally for their samples.

Keeping a top-flight sales force up to date requires continuous training in a vast web of regulations including the Prescription Drug Marketing Act (PDMA); Title 21 Code of Federal Regulations, Part 11 (21 CFR Part 11); the Office of Inspector General Guidelines for Industry (OIG); the Health Insurance Portability and Accountability Act (HIPAA); and a growing network of state regulations. (See "Spot the Quicksand.")

QUIZ: Spot the Quicksand

State Regulations Individual state legislatures and pharmacy boards implement regulations to supplement the federal PDMA, so basic regulations, including rules for sampling midlevel practitioners such as physician assistants and nurse practitioners, vary from state to state. These providers write more than ten percent of all prescriptions, but reps need to know if their state requires a collaborative (with a physician) agreement, a delegation of authority letter (from a physician), or specific state paperwork. Some states have also passed restrictions on or reporting requirements for promotional gifts, personal use programs, scheduled sample mailings, or the value of samples submitted to storage-location inspections. California has even established OIG guidance as state law.