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Detroit Free Press articleFrom: gin11153@aol.comFri Jul 22 03:01:23 2005
The following article has been sent to you from the Detroit Free Press (http://www.freep.com): - - - - - - - - - - - Message: Are they really thinking of discontinuing med samples to doctors? - - - - - - - - - - - Published July 12, 2005 http://www.freep.com/money/business/pharmrep12e_20050712.htm DRUG MARKETING: Freebies for doctors curbed BY KATIE MERX FREE PRESS BUSINESS WRITER You've seen them breeze through the doctor's office lobby. They're usually polished and good-looking. They often tote lunch for the doctor's staff with cases full of goodies. You've probably received one of their free samples. These are pharmaceutical salespeople, and on average, they each generate about $1.9 million in sales a year for the big pharmaceutical companies, investment firm Lehman Brothers reports. But a growing minority of doctors and hospitals say the free lunches, pens and brand-name drug samples they provide affect doctors' prescribing behaviors and drive up the cost of health care. So nationwide, doctors and hospitals -- including the University of Michigan Health System and Henry Ford Health System -- increasingly are imposing strict rules dictating when sales representatives can come calling and what they're allowed to bring. For about two years, the U-M Health System has barred drug representatives and equipment vendors from visiting without appointments and banned acceptance of freebies, including drug samples. While the program kept about $2.5 million worth of free pizza, chicken kabobs and pita sandwiches from reaching U-M doctors' and residents' stomachs, U-M credits the program with boosting generic drug use and keeping inpatient drug costs flat when drug costs have skyrocketed nationwide. This calls into question whether drug samples and freebies drive up the cost of health care by encouraging doctors and customers to opt for expensive name-brand prescription medicines -- one of the leading drivers of rising health insurance costs -- or whether they are a useful tool as doctors determine which medicine a patient should take. Much ado about little? Is it much ado about small samples and trinkets? The free pens, posters, notepads, lunches and occasional trips are all efforts to make doctors think of that drug company's products the next time they're writing a prescription, said Jack Billi, associate dean for clinical affairs at the U-M Medical School. "Many people have viewed those as inducements to prescribing," Billi said. "When you receive a gift, you are subtly beholden in ways you don't even recognize, so the likelihood of you prescribing something" branded is higher. Certainly, the drug company representatives are presenting information with the hope of encouraging doctors to prescribe their drugs before they prescribe competitors' drugs, said Laura Glick, a Pfizer Inc. spokesperson in Michigan. New York-based Pfizer is known for its marketing prowess. It makes such well-known drugs as Viagra, Lipitor and Zoloft and is the self-proclaimed marketing "partner of choice" for smaller drug makers. In Michigan, Pfizer operates major research and development campuses in Ann Arbor and Kalamazoo and employs about 8,500 people. Its Ann Arbor research hub is in walking distance of U-M hospitals. "It makes sense as a business that we would present studies about drugs we've developed," Glick said. "There is a criticism that physicians get the only information about drugs from sales representatives. That's definitely not what's going on. We're there to be a resource and provide useful information to busy physicians." $7 billion to send reps Fairfield, Conn.-based consulting company IMS Health estimates that drug companies spent more than $7 billion last year to send drug reps to physicians' offices. They also distributed free samples valued at about $15.5 billion, IMS reports. By comparison, the industry spent about $4 billion in print and TV advertising. Pharmaceutical market research firm Verispan reports that there are more than 100,000 drug representatives nationwide, about one for every seven doctors, and nearly triple the ranks from a decade ago. This provides some insight into why it is so difficult for employers to take control of the health-care cost increases that are raising employees' co-pays and insurance premiums and pushing large employers such as General Motors Corp. to consider reducing the benefits they provide. For years, California's Kaiser Permanente health system has banned free drug samples and required sales reps to have appointments to meet with doctors. And Dr. Bob Goodman, a New York doctor, started a Web site called http://www.nofreelunch.org to encourage more doctors to forgo freebies. Must have appointment U-M addressed the issue by banning sales representatives from visiting without appointments, providing food, directly sponsoring educational seminars, speaking at U-M conferences, dropping off marketing trinkets, sending unsolicited e-mail to doctors or stuffing flyers in mailboxes. "The last thing we did was eliminate samples," Billi said. It was the piece of policy that met with the most resistance among doctors, Billi said. "Some of our doctors used samples to give to our indigent patients," Billi said. They didn't want those patients to have to pay for the drugs. The problem with that, Billi said, is "eventually patients have to start paying for that drug and they think they need the more expensive drug." It can be difficult to convince patients to switch to a drug they haven't taken before because it's less expensive, even if the chemical composition is the same, Billi said. So U-M hired a nurse to help low-income patients apply to free and reduced-cost drug programs. One reason for eliminating samples, Billi said, was to ensure patient safety. "When a doctor's office distributes samples, they're actually taking on all the responsibilities of a pharmacy," Billi said. "They check for allergies, contradictions ... and expiration dates. Our doctors' offices weren't doing all of that." All brand-name drugs Another reason U-M decided to no longer accept or provide free brand-name drug samples, Billi said, was to ensure that doctors prescribe medicines that provide the best results at the lowest prices. "There are no samples of generic drugs," Billi said. "They're all of brand-name drugs, not preferred brand-name drugs, but the drugs that are trying to gain market share ... We decided that samples encouraged non-ideal prescribing and therefore we wanted to eliminate them." Likewise, Henry Ford Hospital has had a policy in place since 1992 prohibiting drug-company posters in its doctors' offices, requiring drug company representatives to have appointments and barring drug representatives from promoting drugs -- called detailing -- that the health system hasn't approved for use. When U-M put its policy into place two years ago, generic prescriptions made up a little more than 40% of U-M doctors' outpatient orders. Today, generics are about 50% of all prescriptions, said University Hospitals and Health Centers director of pharmacy services Jim Stevenson. Also, since the U-M implemented programs to reduce the influence of drug-company marketing efforts, U-M hospitals' inpatient drug cost per case has remained flat, while nationally drug costs are skyrocketing, Stevenson said. Stevenson said U-M initiated other programs around the same time as its drug rep policies, but believes the drug rep policies contributed to the increased use of generics. "One of my messages ... has been regardless of what kind of drug coverage a patient has, you're better off prescribing the lowest-cost drug," Billi said. "Even if they have a flat co-pay, prescribing the least expensive drug increases the likelihood that they'll have insurance coverage next year." Copyright © 2005 Detroit Free Press Inc.
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