How pharma reps impact physician prescribing

Limiting how pharmaceutical sales representatives can market their products to physicians changes their drug prescribing behaviors, according to a new study in the May 2 issue of the Journal of the American Medical Association.

Detailing-the one-on-one promotion of drugs to doctors by pharmaceutical sales representatives-is the most prominent form of pharmaceutical company marketing. Pharmaceutical companies spend even more money on detailing visits than they do on direct-to-consumer marketing or on research and development of new drugs.

Detailing typically involves small gifts for physicians and their staff, such as meals. In 2015, data from an Affordable Care Act program called Open Payments, determined that about half of U.S. doctors received some form of payment from the pharmaceutical and medical device industries, amounting to $2.4 billion. This included $1.8 million in general payments to doctors, $544 million for ownerships interests, and $75 million in payments for research efforts. It is possible that these payments encourage physicians to prescribe more expensive brand-name drugs and devices instead of less-expensive, generic alternatives.

Larkin

Several academic medical centers have placed restrictions on pharmaceutical representatives’ visits to doctors’ offices but it was previously unknown how these policies may affect physician prescribing. A study, led by The University of California, Los Angeles’ Ian Larkin, sought to determine how practice-level detailing restrictions may affect physician prescribing behaviors.

To conduct the study, Larkin and colleagues compared changes in prescribing habits of thousands of doctors before and after their academic medical centers introduced policies restricting detailing with those of a carefully matched control group of similar physicians practicing in the same geographic regions but not subject to detailing restrictions. In total, the study examined 25,000 physicians and 262 drugs in 8 major drug classes, representing more than $60 billion in aggregate sales in the United States.

“The study cannot definitively prove a causal link between policies that regulated detailing and changes in physician prescribing, but absent a randomized control, this evidence is as definitive as possible,” said Larkin.

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In the end, researchers determined that detailing policies were associated with an 8.7% decrease in the market share of the average detailed drug; before policy implementation, the average drug had a 19.3% market share.

“No medical center completely barred salesperson visits; salespeople could and did continue to visit physicians at all medical centers in the study,” said Larkin. “The most common restriction put in place was a ban on meals and other small gifts. The fact that regulating gifts while still allowing sales calls still led to a switch to cheaper, generic drugs may suggest that gifts such as meals play an important role in influencing physicians.”

Researchers suggest that physician practices and other governing bodies may need to take an active role in regulating conflicts of interest, rather than relying on individual physicians to monitor and regulate.