States Combat Drug Reps to Cut Costs

Drug information consultant Leigh Bradshaw of Independent Drug Information Service talks with Dr. Ernest Josef at his practice near Enola, Pa. on Wednesday, Feb. 13, 2008. Pennsylvania is among a handful of states trying 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. (AP Photo/Jason Minick) (Jason Minick - AP)

With generic drugs already accounting for two-thirds of all prescriptions, the pharmaceutical industry's main trade group questions the value of the "unsales" programs.

The group said care could suffer if steering patients to generics is the primary objective _ which the programs deny. It also maintained that state consultants are not held to the same strict standards as drug company reps in their presentations.

"A less expensive treatment may be more costly in the long run if it is not the best therapy for the patient," Ken Johnson, spokesman for The Pharmaceutical Research and Manufacturers of America, said in a written statement to The Associated Press.

Bradshaw said generics are not pushed "unless the generic is the better choice," noting there are cases where brand-name products are deemed the most effective.

States are clearly outgunned.

The industry spends more than $7 billion a year on direct marketing to doctors and employs about 90,000 salespeople _ one for every five doctors, according to the Prescription Project, a campaign funded by The Pew Charitable Trusts to challenge pharmaceutical marketing practices.

Still, Pennsylvania reports some slight cost-control success in its assistance programs, which last year enrolled 360,000 people 65 and older and cost the state $325 million, up more than 30 percent in the last decade.

For patients of nearly 300 participating doctors, average monthly spending on some pain relievers dropped from $400 to $340 per doctor within six months after a state consultant visit, a preliminary analysis found.

Another analysis found that the program saved Pennsylvania about $572,000 a year alone on heartburn drugs.

In both instances, the state took into consideration other factors influencing doctors' prescriptions _ such as publicity about dangerous side effects and a strong push for generic drugs by insurance companies, said Thomas Snedden, director of Pennsylvania's prescription drug discount programs. The evaluations included control groups of doctors who either did not participate in the program or practiced in counties where it is not offered.

To develop Pennsylvania's program, state officials consulted with Dr. Jerry Avorn, a Harvard Medical School professor who pioneered the practice in the late 1970s.

He determined that the best way to combat industry marketing was to try to beat them at their own game _ by using the industry's basic tools to tell medical professionals about a broader base of medical research in a more engaging style than the pedantic lectures he endured as a medical-school student.