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Health Care Tour: “Seeking Patient-Centered Care”

Pharmaceutical Representatives Roundtable

The Issue:

• Pharmaceutical representatives influence physicians’ prescribing practices. They also benefit physicians in terms of education/research and the samples they give that get passed on to patients (something many patients don’t even realize). Pharmaceutical companies are also coming under fire for the escalating cost of medicines and for advertising practices that may boost utilization rates.

Findings:

• Drug therapy in general can be a cost effective form of health care. Appropriate pharmacological therapy can decrease health care costs long term for many conditions.
• Pharmacological representatives see their jobs as one of service and education for the physician about the benefits and contraindications of drug interactions with most visits at a breakfast or lunch meeting with physicians as the only available time to meet.
• Most major drug manufacturers participate in significant free and reduced price programs for community clinics and community-based care. Free samples to physicians are a small part.
• While direct-to-consumer advertising can increase drug utilization rates by creating consumer demand-pull, it also can help the public to identify early symptoms of a condition.
• Medicaid is the largest health care provider in South Carolina and all medicines are provided for $3.
• Years ago, free samples to doctors were almost unlimited, now they are far more controlled.
• Pfizer provided $29 million in free or reduced price medicines in South Carolina, $2 million to the New Horizon Clinic in Greenville.
• Novartis provided $270 million total in free or reduced price medicine programs.
• One representative contended that one-third of the medicines being sold as re-importation drugs from Canada are not really from Canada and represent a safety risk to the public.
• New ethics rules are requiring reporting of any gifts over $100 to doctors and clinics from pharmaceutical companies.

Roundtable Discussion:

Pharmaceuticals have joined the list of health care benefits that patients believe should be low cost or free along with all doctors’ visits.

Congress often allows pharmaceutical companies to become the villain of health care because of profits or CEO salaries, but the costs of introducing new drugs and length of time to market are rarely discussed in counter to that along with the drug companies’ free medicine programs. It is hard to see the cost of R&D programs.

Patient compliance is also a major factor for patients who refuse to comply with physician recommendations. This can result in more and more medicine to treat the symptoms, ie: hypertension from being overweight.

For physicians, a goal with patients is to direct how they might take care of their health so they do not need to take the drug.

Doctors cannot prescribe personal accountability.

Without electronic medical records, the first line of defense for contraindications of drug interactions is a physician, but primarily the pharmacist. The pharmacist needs to have patient prescription records to understand what drugs might not work together.

Background articles

Wall Street Journal, June 4, 2008, Health Blog, URL for the article: http://blogs.wsj.com/health/2008/06/04/novartis-ceo-on-the-downside-and-upside-of-drug-ads/

“The FDA and Congress have been coming down pretty hard on drug safety issues lately. Novartis CEO Dan Vasella, said one reason may be unreasonable expectations created by direct-to-consumer ads.

“As a seller, you want to promote the benefit and not so much the potential downside,” he said today during a chat with the Health Blog and a few of our WSJ colleagues. The pharmaceutical industry doesn’t “show advertisements where drugs are being portrayed as serious, potentially dangerous interventions.” Instead, he said, “it’s all with the people happy and healthy and hugging each other, and it’s the sun and flowers.”

But the ads, despite their flaws, also serve an important public health function, he said, by getting people to go see the doctor about serious health risks, such as high blood pressure and high cholesterol that often go undiagnosed and untreated…

Wall Street Journal, May 20, 2008, Health Blog, URL for the Article: http://blogs.wsj.com/health/2008/05/20/why-selling-drugs-is-like-selling-ketchup/?mod=WSJBlog

Joe Jimenez, the guy who recently took charge of Novartis’s pharmaceutical division, spent most of his career in the packaged goods business. He hopes to bring some of the tricks of that trade in selling to supermarkets to bear on the prescription drug business, the WSJ reports as part of look at Novartis and CEO Dan Vasella.

One strategy is “key account management,” which, for a packed-goods company (like Jimenez’s former employer H.J. Heinz), means building good relationships with important retailers. “That tends to help your business over the long term,” Jimenez says.

In the drug business, that may mean building better relationships with insurance companies. Jimenez has launched several pilot projects to that end. In the Pacific Northwest, the company (which sells lots of blood pressure drugs) is paying to train an HMO’s nurses in some aspects of heart disease…”

May 19, 2008; URL for this article: http://www.news-medical.net/?id=38399

Fifty-one percent of insured U.S. residents last year took one or more prescription drugs for chronic diseases, compared with 50% in the previous four years and 47% in 2001, according to a report released last Tuesday by Medco Health Solutions, the AP/Houston Chronicle reports.

For the report, Medco examined the prescription records of a representative sample of 2.5 million customers from 2001 to 2007. Last year, almost two-thirds of women ages 20 and older, one in four children and teenagers, 52% of men and three-fourths of seniors took prescription drugs for chronic diseases, according to the report.

The report also found that:

• Hypertension and cholesterol medications were the most commonly prescribed last year;
• 28% of female seniors and 22% of male seniors last year took five or more prescription drugs regularly;
• Use of prescription drugs for chronic diseases increased by 20% among adults ages 20 to 44 from 2001 to 2007, in large part because of increased use of depression, diabetes, asthma, attention deficit hyperactivity disorder and seizure medications;
• About 1.2 million children took prescription medications for type 2 diabetes, sleep disorders and gastrointestinal problems last year; and
• Asthma medications have replaced allergy treatments as the medications most commonly prescribed to children.

Response

Experts attribute the results of the report to "worsening public health," improvements in prescription drugs for chronic diseases and the "pharmaceutical industry's relentless advertising," and physicians expect the percentage of U.S. residents who take such medications to increase in the future, according to the AP/Chronicle.

Daniel Jones, president of the American Heart Association, said that, because "body weights are so much higher in children in general ... we're going to have larger numbers of adults who develop high blood pressure or abnormal cholesterol or diabetes at an earlier age."

Robert Epstein, chief medical officer at Medco, said, "We've become a couch potato culture, (and) it's a lot easier to pop a pill" than diet or exercise regularly (Johnson, AP/Houston Chronicle 5/14).

 

When: May 28, 2008 (1:30 – 3:00 p.m.)

Where: University Center Board Room, 225 Pleasantburg Drive

Hosts: Jim Mac Millan, M.D. (Gateway Family Medicine of Travelers Rest), Mark Harris (Phizer), Susan Chappell (AstraZeneca), Jill Perone (GlaxoSmithKline), Brian Kenna (Novartis), Cindy Carrigan, RPh (Amylin), Bob Schmidt (Manager, AstraZeneca), Maribeth Wright (Novartis), John Eberly, M.D. (Family Medicine), Mike Rickoff, M.D. (Piedmont GI)

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