States Combat Drug Reps to Cut Costs
Monday, March 3, 2008; 2:47 AM
ENOLA, Pa. -- Leigh Bradshaw could be mistaken for a drug-company sales rep as she pulls out charts and leaflets to tell Dr. Ernest Josef about the costs and benefits of various cholesterol-lowering drugs.
But notably absent during her visit to his family practice is the swag typical of a pharmaceutical marketing arsenal _ the free pill samples, the logo-emblazoned pads and pens, the free lunch for doctor and staff.
That's because Bradshaw, a registered nurse, isn't trying to pitch a product for a drug manufacturer. She works for Pennsylvania taxpayers.
In a David vs. Goliath battle, Pennsylvania is among a handful of states trying _ with modest results at best _ to counter the pharmaceutical industry's multibillion-dollar marketing and cut costs for prescription-aid programs for senior citizens, who are bombarded with "ask your doctor" advertising.
"The more times they see it on TV, they feel that implies it is a better drug, which might not necessarily be the case," Josef said.
Josef, who is 45 and has been practicing medicine for 16 years, said he had already begun prescribing more generic cholesterol drugs in response to patient cost concerns, but that Bradshaw's presentation gave him more information to back up his recommendations.
State officials here say they are trying to ensure that patients get the most effective treatment. But driving the outreach is an effort to hold down expenses _ in some cases by steering doctors to generics, in others by showing how lifestyle changes can sometimes be preferable to medication.
Pennsylvania is not the first state to try what is known as an "unsales" strategy, but its program, begun in late 2005, is considered the most extensive. The state spends $1 million a year on its "unsales" force _ 11 consultants, including some former pharmaceutical salespeople, assigned to the 28 counties with the highest concentrations of seniors enrolled in discount drug programs.
West Virginia ran a similar program in two cities from 2003 to 2005. Vermont has a program focusing on rural medical practices and South Carolina began one last fall, focusing on mental-health prescriptions.
In visits with doctors, Pennsylvania's consultants share findings such as:
_The cost of a 20-milligram daily dose of various cholesterol drugs can range from 13 cents for generics to $4.53 for one of the more expensive brand names.
_A 30-day supply of some popular brand-name heartburn drugs can cost anywhere from $111 to $124, compared with just $1 to $2 for an equivalent supply of over-the-counter antacids.