Turkey: Honorarium Payments To Healthcare Professionals

Pharmaceutical companies, physicians, pharmacists, academicians, pricing and reimbursement officers... Each of these is an important stakeholder, who has a critical role in presenting the most effective treatments to patients. In that respect, all of these interact with each other under certain rules and regulations. One example is that pharmaceutical companies, who are the marketing authorisations holders of pharmaceutical products, need to receive professional assistance of healthcare professionals as well as key opinion leaders, academicians and other specialists (all will be referred to as "HCPs") in the process of developing medical content and disseminating such information to other HCPs.

The most frequent forms of the professional assistance received from HCPs are speaker services and advisory services. In the first one, HCPs attend scientific symposia and congresses to deliver speech and presentation on a scientific topic, while on the other such contribute in preparation of a medical content or material. In return of the professional services provided and the time allocated, a fee called "honorarium fee" is paid.

All over the world, interactions between HCPs and pharmaceutical companies is a debated area. To prevent any conflict of interest, official authorities and public expect more transparency. In that respect, governments do their best to minimise the financial interactions. As detailed below, this is also what has happened in Turkey as the Government through the law making process before the Turkish Parliament amended the legislation to prevent such interactions as much as possible.

Although it may be understandable why such a sceptical approach is taken, it should also be taken into account that such medical advisory services are necessary indeed not only for pharma companies and physicians but also in the ultimate plan the public, as public has the utmost right and benefit in developing the medical intellectual capacity in the pharmaceutical area.

Surely, also the pharma industry supports that this area is regulated by certain rules and regulations. In particular, originator pharmaceutical companies, which are foreign capital companies and in most cases do care about complying crossborder legislation such as FCPA, UK Anti-bribery Act, are willing to take all the necessary precautions to prevent any breach to the local legislation and ethics rules.

In the light of the foregoing, we have deemed necessary to provide information on the current legal status regarding honorarium payments.

1. Current Legal Framework in Turkey

Currently working conditions of HCPs and honorarium payments made to HCPs are stipulated under the Decree Law with No. 650 published in the Official Gazette on August 26, 2011. The Decree Law with No. 650 amended various laws including the following:

  • Law on Public Servant, No. 657, Article 28: Public servants cannot operate bureaus, offices and private clinics to perform professional activity or self-employed work; neither can they work at workplaces of private entities or institutions in the nature of public institution or foundation universities.
  • Law on Higher Education, No. 2547, Article 36: Academics (only professors and assistant professors) can perform professional work after working hours, provided that they do not receive revenue from the revolving fund administrations of their institutions.
  • Law on Military Medicine Academy Law, No. 2955, Article 32: Academic personnel of the civil and armed forces (only professors and assistant professors) can perform professional work after working hours, provided that they do not provide services at their institutions regarding treatment of soldiers and they have obtained permission from the Turkish General Staff.

In accordance with the mentioned amendments, the Decree Law with No. 650 stipulated a restrictive approach with respect to HCPs working on his/her account. In summary, all public officers were prohibited from working on their own account both during and after working hours, however, physicians with academic status (civilian or soldier) could work on their own behalf provided that they do not generate income from revolving fund of the institution that they work and they performed such study after working hours. Another controversial dimension of the matter was related to copyright payments. We evaluate that copyright payments that could be made to HCPs should be literally interpreted, since an intellectual or artistic work must exist in order to make a copyright payment. We evaluate that in case HCPs who are public officers and HCPs with academic title who created a work, which has no relationship with the official duty of the HCP, copyright payment could be directly made to the HCP.

However, the Constitutional Court repealed the Decree Law with No. 650 a year after its publication, on July 2012. Nevertheless, the repeal decision is not yet published on the Official Gazette, and will enter into force one year following its publication. The grounds of the repeal decision are the procedural rationales. The Court did not state any evaluation with respect to substantial aspects of the Decree Law. Therefore, we evaluate that the decision did not change the current legal status with respect to payments made to HCPs.

2. Transparency with regard to the Relationships between Pharmaceutical Companies and HCPs

Meanwhile in Europe, the pursuit for transparency with regard to the relationships between pharmaceutical companies and HCPs has also been a topic of discussion. The Directive 2001/83/ EC of the European Parliament and the Council dated November 6, 2001 relating to Medicinal Products for Human Use ("Directive"), concentrates on many aspects of the promotion of medicinal products. However, the Directive does not comprise any provision regarding disclosure or reporting requirements on (honorarium) payments to HCPs. Therefore, EU member states are not required to regulate any such obligations in their national laws, but some European countries regulate this area. For instance, the French government enacted a transparency act, namely "La Loi Relative au Renforcement de la Sécurité Sanitaire du Médicament et des Produits de Santé" (The law relating to improvement of the health security of drugs and healthcare product) in December 2011 which was deemed as a major and comprehensive reform of the French healthcare system. This act stipulates reporting requirements and two main types of transparency rules; (i) public declarations of interest that HCPs must make concerning their relationship with pharmaceutical companies, and (ii) disclosure obligations imposed on pharmaceutical companies concerning their interactions with HCPs.

In the meantime, the European Federation of Pharmaceutical Industries and Associations (EFPIA), of which Association of Research-Based Pharmaceutical Companies (AIFD) is a member, released the Code on Interactions with Healthcare Professionals, which does not contain actual reporting or disclosure requirements. However, it encourages pharmaceutical companies to ensure that information, regarding donations, grants or benefits provided to institutions, organisations or associations comprised of HCPs, are publicly available. Furthermore, the EFPIA Code on Relationships with Patient Organisations contains reporting requirements. The requirements apply to activities initiated as of or ongoing on January 1, 2012, with the first reports to be made public by the end of the first quarter of 2013.

Finally and most recently, EFPIA Draft Code on Transparency of Payments to HCPs and Healthcare Organisations has been prepared and discussed. With the virtue of this Code of Transparency, EFPIA is preparing to require member associations to impose a requirement to document and disclose payments and other transfers of value directly or indirectly for the benefit of the HCPs and healthcare organisations. The Disclosure is designed to be made annually and standardised templates shall be used.

The Ministry of Health has recently mimicked the EFPIA's Draft Code of Transparency's approach. On October 14, 2012 the MoH published amendments on the Regulation on Promotional Activities of Human Medicinal Products and required HCPs to mention/disclose all sorts of sponsorships received at the end of each scientific article and/or at the beginning of every speech/ presentation.

3. Conclusion

As summarised above, we are in a transition period where the issue of honorarium payments seems to be debated for a further while. The legislation will be amended at some point in light of the Constitutional Court decision. However, we evaluate that there are already certain rules in place to be considered in determining the necessary actions to be taken. Therefore, it would be reasonable to follow the wording and the spirit of such rules and prefer to remain on the safe side to avoid any possible administrative and/or legal risk.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Some comments from our readers…
“The articles are extremely timely and highly applicable”
“I often find critical information not available elsewhere”
“As in-house counsel, Mondaq’s service is of great value”

Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.