Disclaimer: the article only represents one side of the issue. While the author is speaking from their experience, the article should be viewed as the opinion of the author and thus does not necessarily represent the practice of all involved in the pharmaceutical industry.
We have discussed this issue to some extent in terms of conflict of interest as healthcare providers, but during this discussion I would like us to consider things from the side of the pharmaceutical companies. After reading the article, please consider the following:
Should there be tighter restrictions on the pharmaceutical industry? If so, should they be federally, state or self-imposed?
Is direct-to-consumer advertising effective for educating the consumer or does it simply place prescribers in the position of feeling pressured to satisfy patient requests?
Are sample medications effective at reducing healthcare costs in the short-term? Long-term?
16 comments:
I like the idea of a pharmaceutical representative providing information. However, I definitely agree that the unofficial definition of a pharmaceutical rep is more accurate. "Change the prescribing habits of physicians." Normally, these are the people that the doctors rely on for information. The problem with this is, this information is more persuasive rather than informative.
I would be nice if drug reps would focus on giving doctors viable information about their drug, and then let the doctors decide to use the drug. The drugs reps get away from the idea of patient care when they focus on getting the doctors to prescribe their drugs by any means necessary.
How do you feel about television advertisements for prescription medications? Helpful or harmful? Why?
Do you believe that "gifts" truly influence how a doctor prescribes? How does it affect you as a pharmacist?
Do you think direct-to-consumer advertising will add more pressure on the physician to prescribe things that might not be the optimal option.
Do you think that commercials and public advertising for medications and certain conditions have an impact on prescribing/filling patterns of doctors/pharmacists, respectively?
Personally, I am against pharmaceutical representatives supplying physicians with sample medications. I feel this way because the physician may begin by supplying the patient with these samples however will most likely not continue to supply these samples in the future. So, when the time comes for a refill the patient will end up paying for the brand name drug when they could have paid for generic if the physician had not been influenced by the pharmaceutical representative to write for a brand drug.
On the other hand, I do not see any problem with pharmaceutical representative supplying physicians with information regarding their drugs because as noted in the article posted by Dr. Nuzum over 50% of physicans cited drug reps as their main souce of information regarding new drugs.
Do you think that banning all these "gifts"/promotions would affect pharmaceutical sales? Do you think drug reps have to learn entire new tactics to persuade doctors in prescribing their medications?
I agree with Ray in the fact that I feel pharmaceutical reps often focus so much time and attention on promoting the medication that this ultimately compromises patient care. With them pushing so many promotional items on physicians, the physicians are persuaded to maintain this "loyal" relationship by prescribing a given medication even if it isn't the best medication for the patient. All because they want more free food and "goodies" and so the drug rep will stop wasting their time. I don't really see a problem with giving pens, pads, etc. that advertise a drug, but I do see a problem with free dinners, golf bags, and other gifts that are just excessive in my opinion.
After working in independent pharmacy now for a little over a year I definitely feel that the doctors are influenced by drug reps/companies. I spend a lot of time talking to doctors on the phone trying to get these "brand new, hot off the press" meds out of their brains. Now don't get me wrong I am thrilled to see new drugs developed, but it is quite obvious when a drug rep is in town and I see the same prescription written multiple times throughout the day. I just don't believe it is always in the best interest of the patient.
Pharma reps:
I do think that most physicians rely on the pharmceutical reps to be their first line for new drug information. In speaking with the geriatricians I work with, most of them do not have an office base practice and they are most likey to use new products after they have been detailed by a rep. If they have no access to a rep, it does take substantially longer for them to consider using it.
Drug Ads:
We do see a lot of family members of residents in the nursing home come in and ask about medications that they see on T.V. Most often thy do have a mis-perception about the product and in some cases have a hard time understanding why a certain medication is not an option for their family member.
Samples:
Samples are not allowed in long term care facilties but in speaking with geriatricians that have office based practices, they tell me that they do see a role for samples. They still have many patients who do not have health insurance and those who cannot afford a monthly drug co-pay(which are increasing yearly for seniors in a Part D plan). They will often treat acute problems with samples to ensure that the patient can get the therapy they need without an access problem.
I have mixed feelings about pharmaceutical samples.... I believe in the short-term, they may provide patient's with valuable savings; ie, a patient may not be able to tolerate an expensive medication and thus, can determine this prior to paying for a prescription.
On the other hand, samples are usually for brand name drugs, expensive medications, or new medications. It is not uncommon in my area that patients begin taking samples, and then can't afford the medication and don't continue taking them which results in many other problems for the patient and takes up more healthcare resources. I also feel that as pharamcists, it is very important that we know ALL the medications our patients are taking - when patients are given samples, it is hard to keep an accurate medication profile. Finally, I feel that samples may persuade physicians to prescribe medications that may not be the most optimal medication for their patients simply because they have samples --- and patients LOVE getting things for free and many will request samples from their doctor's office.
I prefer the 'free trial' cards that drug companies are using to get the patient started at a lower cost, or at no cost. This allows the pharmacy to process the medication and keeps the medication profile complete. It also allows the patient to get a prescription and thus an idea of the cost of the medication with their insurance before they even get the discount from the card.
It's sad that doctors rely almost solely on drug reps for their information concerning new and updated drugs. Knowing this, drug reps have it down to a science as to how they should "treat and bribe" each physician. Because doctors rely so much on drug reps, it leaves the door wide open for drug reps to come in and invade by persuading doctors into writing prescriptions that may not be best for the patient.
Just as Dr. Campbell mentioned, I too have mixed feelings about samples. I believe that they can benefit some patients. For example, I volunteer at an indigent care clinic and many of the volunteer physicians will bring their samples to the clinic for us to dispense. We will then place those patients on prescription assistance programs if they have a positive response to the medication or it is needed.
On the other hand, I believe samples can lead to less than ideal prescribing habits, especially with the "me too drugs." If the medication works for the patient, then the physician will be more likely to prescribe this for a large cost to the patient or worse yet a prior authorization for insurance coverage. Unfortunately, in my experience, the patient is more likely to say that it works in hopes that the physician will provide them with more free medication.
Unfortunately, the physicians will always be looking for shortcuts to catch up on information regarding new medications. It is hard to place the blame on them. They are busy with many other things and it is difficult for them to keep up with all the new changes in medications and practice. Despite the elimination of "gifts," I believe the physicians will continue to listen to what the pharmaceutical reps have to say. After all, they do provide an excellent song and dance for those willing to listen and have done so successfully for many years. Therefore, it will be our responsibility to provide them with unbiased, reputable information to improve the overall healthcare for patients. Now is a better time than ever.
I think that it is important to have drug reps visits physician's offices, they supply the latest information on new drugs. Although, I do not feel that the drug reps should be pushy about promoting their product, but more informative. From past experinece working in a physician's office I have seen both sides of the spectrum, the pharmacy side and the doctor's side. Most of the time physicians don't even have time to talk with the drug reps and they simply sign for samples and leave literature about the drug. Therefore, I do not feel that all physicians are as greatly influenced as others. Basically I think that drug reps should continue to promote their drug, but physicians need to be more careful when prescribing new drugs...maybe not be so eager.
I think the chart located within this article is a testament to what is wrong with our health care system. Here we have a pharm. sales rep who basically lays out his game plan, very strategically I might add, which really boils down into him cornering a physician into prescribing his product.. even if the product is not any better for the patient than the current market "standard".
This is in my opinion is really screwed up. Our goal should be to do whats best for the patient - not just in a therapeutic sense but also take into account other issues like drug cost, adherence issues (ex: easier for pt. to remember "qd" rather than "bid" etc. ). All of these things should go into the decision making process when a physician prescribes, because every prescription should be catered to the individual and cost happens to be a huge issue in many people's eyes.
Until we can move past viewing health care as just another marketing opportunity I feel like we will always have issues with high insurance costs and general "wastefulness" that we experience every day in our nation. This is why I disagree strongly with pharm. sales reps courting physicians with things like free air miles, trips, lunches, pens etc. Instead of marketing drugs, why can't manufacturers just set up CE sessions across the nation in which physicians and even pharmacists for that matter can go and learn about the DRUG and decide for themselves as to its superiority over another therapeutically equivalent drug? As a future pharmacist, I would appreciate a professional presentation on a drug rather than having some scumbag sales rep. try to buy my cooperation and void my professional judgment.
-Dustin (P1)
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