JAMA Publishes Physician Influence Study
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?Critics usually blame DTC for these patient requests.? |
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A study conducted by The Morgan Institute for Health Policy at Massachusetts General Hospital has some potentially controversial results for brand marketers. The study was done via the web with 1891 responding doctors. The study was designed to measure how doctors are influenced by drug rep and drug company goodies. The bottom line results are that doctors who take free food or beverages are more likely to prescribe brand versus generics when patients request brands.
The numbers are statistically significant with 39% of those who got freebies complying with patient requests for brands versus 33% of doctors who did not get free food. It also held true for those receiving drug samples at 40% versus 31% not receiving. The study author concludes that doctors who partake in freebies and sampling are more likely to comply with patient requests for brands. This is a problem, the author says, because of costs of brands.
I guess the study shows doctors are human. If some rep buys the office a pizza, they get some goodwill in prescribing behavior. The study does not show what happens at the pharmacy. We do not know if the prescriptions are written with the instructions to allow for generic substitution. We do not know the true cost of the differences in reported behavior.
The study is not surprising. Physicians who see reps develop relationships. Getting new information on drugs is important to that set of doctors and reps are a good source. The physicians who refuse to see reps, take samples or have an occasional lunch meeting might be missing new information. We just do not know from this study.
What is risky for the DTC Industry is that the media and government critics usually blame DTC for these patient requests. With cost pressures rising for our health system, anything that raises brand demand when generics are available will surely get scrutinized.
Even if the data in this study is projectable to the doctor universe, one has to wonder if patients end up with the branded drug. Our insurance companies have tiered co-pays so a patient will generally pay more for a brand if a generic is available. Once at the pharmacy the patient who requested a brand name will take the generic when the pharmacist tells them the cost difference. I think the end result is very few patients will get a more expensive brand if a generic is available. Our payer system is very cost conscious. PBM?s and the formulary process ensure most patients only get expensive drugs when no cheaper alternative exists.
While this study is interesting, I doubt more detailed studies will show a significant cost increase to the system. We need to see the actual pharmacy data to determine if patients actually are getting the branded drug. In some cases doctors are cautious about certain categories where there is risk in changing what works. Epilepsy is an example where doctors might be reluctant to change because of the risk of a generic not doing exactly the same job. Generics are allowed to have some chemical differences and these may make a difference in how the body reacts.
In any case, a knowledgeable patient and doctor should always consider cost a key factor in the prescribing decision. That is not hard to do in today?s ease of access to drug costs.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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