>From another list,,, cheers Ken Hanly> Doctors Hear Alternatives To Drug-Firm Sales Pitches > >By Marc Kaufman >Washington Post Staff Writer >Monday, August 5, 2002; Page A01 > >Marcia Drummond sees doctors for a living. On a typical workday, she may >drive from Upper Marlboro to Silver Spring to Alexandria to Northeast >Washington to visit pediatricians, internists, cardiologists and family >practitioners. She is a pharmacist by training, but she's now a foot soldier >in a mounting clash between the pharmaceutical industry and the benefit >plans that pay for their products. > >For years, the pharmaceutical industry has been sending salespeople called >"detailers" to doctors' offices to promote their latest patented blockbuster >drugs. > >Drummond is a "counterdetailer" -- a paid consultant for a prescription >benefit company whose job is to question those sales pitches, to counsel >doctors to look at cheaper and generic drugs whenever appropriate. And the >rise of this figure in the health care landscape has opened another front in >the battle to control prescription drug costs, which have been rising more >than 17 percent yearly since 1997. > >The most public front was active last week, with the Senate passing a bill >intended to make it easier for cheap generic drugs to come onto the market. >The bill, sponsored by Sens. Charles E. Schumer (D-N.Y.) and John McCain >(R-Ariz.), drew considerable support in Congress and strong opposition from >the pharmaceutical industry. > >But the less visible fronts are constantly active, especially now that drug >costs are straining budgets for governments, corporations and unions. And >because the most direct way to manage drug costs -- setting the kind of >price ceilings found in most other countries -- is politically unacceptable, >those involved have had to be inventive. > >The advocacy group AARP, for instance, began a $10 million advertising >effort this spring to encourage the use of generics and cheaper drugs, using >veterans of anti-smoking ad campaigns. The Food and Drug Administration will >also soon start a major effort, mandated by Congress, to explain that >generic drugs are as safe and effective as the brand-name drugs they copy >after patents have expired. Major corporations joined unions and health >advocates joined managed-care companies in supporting the Schumer-McCain bill. > >Then there are counterdetailers, targeting doctors. The states of West >Virginia and Michigan have hired their own counterdetailers to visit doctors >and encourage them to prescribe generics whenever possible. Legislators in >other states, including Vermont, Massachusetts and Washington, have proposed >or passed similar programs. First Health Group Corp., which manages >prescription benefit plans in 14 states, reports that the states' interest >in counterdetailing is growing fast. > >It is no coincidence that all this activity on drug costs has occurred as >Congress has tried, albeit unsuccessfully, to fashion a Medicare drug >benefit that would give coverage to the elderly. > >"There is a widespread feeling that there has to be a one-two punch on >prescription drugs, that for them to become more accessible they first have >to become less expensive," Schumer said. "If nothing is done on the cost >side, then obviously it makes it much harder to act on the accessibility side." > >To the large and powerful pharmaceutical industry, selling more brand-name >drugs is both good and appropriate for health and business reasons, and it >is aggressively fighting efforts to limit drug companies' prices and profits. > >The industry spent $2.5 billion last year to advertise new and generally >more expensive prescription drugs, according to published reports. Its trade >organization says there were more than 86,000 detailers visiting doctors, >hospitals and nursing homes last year. The industry now has more than one >paid lobbyist for every senator and congressman in Washington -- and >products that most Americans use and value. > >The result has been an unprecedented increase in drug spending in recent >years -- largely because of increased usage, rather than price inflation. >Although Americans have become more willing to use generic drugs, most of >the money is still going to the name-brand companies. According to recent >congressional testimony, almost 50 percent of prescriptions now are for >generics, but more than 90 percent of drug spending is still for the name >brands. > >Persuading doctors to prescribe generics -- and patients to use them -- can >bring enormous savings. As explained by Tom Susman of the West Virginia >Public Employees Insurance Agency, 43 percent of prescriptions paid by the >plan are now generics. If that number grew to 45 percent, he said, the state >would save $1 million. That's why he is beginning the state's >counterdetailing program, and why the work of people like Marcia Drummond is >drawing increased interest. > >She works for the prescription benefit company AdvancePCS, which has its own >financial reasons for wanting to control drug costs but whose goal is shared >by many others, including some generally critical of managed care. New York >doctor Robert Goodman, for instance, who runs a program that highlights >improper drug-company promotions to doctors, applauds private >counterdetailing efforts because "it's essential that doctors get drug >information from sources other than just drug company reps." > >The AdvancePCS program began several years ago, and now sends out 150 >counterdetailers to visit 20,000 of the nation's top prescription-writing >doctors each year. The goal, as Drummond described it, is to discuss with >doctors the drugs they're prescribing to make sure the patients are getting >the most appropriate -- and least expensive -- medications. > >She has printouts that document each prescription filled under the doctor's >name, so she can get very specific about whether a physician is prescribing >expensive name brands or generics and "preferred" drugs on the company's >approved list, or formulary. She can recommend changes, based on her >knowledge of drug properties and costs, but cannot go beyond that. > >"They don't always change what they're prescribing," she said of the >doctors, "but they're usually interested, and they listen." > >One doctor she visits regularly is Azher Hussain, who has a family practice >in College Park. He said that he views counterdetailers such as Drummond as >different from drug company sales representatives. > >"Yes, they encourage us to use generic or their preferred drugs, but >sometimes they also recommended more expensive ones," he said. "The drug >reps, they always say their drugs are best." > >Generally, Hussain said, patients don't mind if he substitutes a generic >drug for a name brand, although he says that at least one in four later say >they want to go back to their old drug. > >The American Medical Association supports counterdetailing that helps >doctors learn more about drugs, and especially about their costs, but also >worries the practice can be abused. > >"The danger from the perspective of the physician is that they will be >coerced into using a drug that might be cheaper, but not as effective," said >AMA board chairman J. Edward Hill. "Education is fine, but forcing the use >of only cheaper drugs is not." > >The Pharmaceutical Research and Manufacturers Association has a similar >position. "The final decision on what drug to prescribe must remain with the >doctor, not with a health maintenance organization or a prescription benefit >manager," said association spokesman Jeff Trewhitt. > >AdvancePCS said its counterdetailing program had reduced its drug costs >between 1 percent and 3 percent. Since studies have estimated the nation's >bill for prescription drugs to be $175 billion last year, the savings could >be significant if counterdetailing became more widespread. > >According to AdvancePCS Vice President Lori Bymark, some earlier >counterdetailing programs foundered because they focused almost exclusively >on cost, and on whether doctors were prescribing according to formulary >lists. Although issues of cost are still central, she said, their >counterdetailers -- or, as they prefer, "clinical consultants" -- also >provide information about potentially harmful drug combinations, drug >recalls and drug studies. > >"We hire only trained pharmacists, and their reliability is our most >important asset," said Bymark, who runs the counterdetailing program. "We >think this effort has enormous potential for reducing costs and improving >health." > >Although the kind of private counterdetailing used by AdvancePCS is >relatively new, the idea of providing doctors, hospitals and nursing homes >with more independent information about prescription drugs is not. Jerry >Avorn, a professor at the Harvard University Medical School, has been >studying and advocating what he calls "academic" detailing since 1979, and >he says it has been proven to work. > >"We established long ago that doctor prescribing habits are clearly >influenced by [drug company] sales reps, and they can be changed by others, >too," Avorn said. "Doctors learn very little about drug costs in medical >school, but they're open to hearing from knowledgeable people about it." > >Avorn believes this kind of "unadvertising" is now spreading fast, and has >become "an important information service in the health care industry." > >But the best advertising for drug companies has long been the free samples >their detailers leave at doctors' offices, and today's counterdetailers >don't have samples to give. A spokesman for the Generic Pharmaceutical >Association, however, said his industry would like to change that. In the >future, he said, patients may be going home with generic samples, too.
