PhRMA Marketing Brochure Influences on Prescribing FINAL

8/3/2019 PhRMA Marketing Brochure Influences on Prescribing FINAL

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Pharmaceutical marketing in PersPectiveIts Value and Role as One of Many Factors Informing Prescribing

O o o p o p op o d o o bo d o p o o . t o b w p

p d p o o od o d p o o o . W o ,

p o o wo d b y o , o o b d p -

p o d , w p y o .

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o o d o bo o o d b o d d.

P p od o p o o ww d d d , w dod pd o y d o

o o o p ppo p p d

p o d . Prescription Marketing Helps Addresses TreatmentW p o

o o o d , d ow d d d o d

y o d o o y o bo d.1 P


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G p t Tr tm t D :T R t

ranD o b d p bAnnals of Internal Medicine o d w qo d d o d o

d, 50 p o w bd d o w o p b d, w w d b pp op

w p b d.5

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c o o d o x y ocDc, p op w o o d o o75 p o o p d12 Fo x ph d d mit w b ood p w d o

yp d , dd o 8d d 420,000 o p z o wo

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Pharmaceutical Marketing Helps Raise Awareness About Treatments or Chronic Diseases, the LeadingDriver o Health Care Spending.c o o d o

d b , d p o , yp o d y p . m y p w o -

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o w yp p d d o d o d o db d.11

Source:1D. Cutler, et al., The Value o Antihypertensive Drugs: A Perspective on Medical Innovation, Health Affairs, Vol.26, No. 1, 2007: 97-100;2Centers or Disease Contand Prevention (2006),Health, United States, 2006, with Chartbook on Trends in Health of Americans, National Center or Health Statistics, p 559.

e f f e c Ti Ve u s e o f a n Ti h y P e RTe n s i Ve M e D i c i n e sc o u l D a Vo i D a n a D D i Ti o n a l 8 9 , 0 0 0 D e a T h s a n D

4 2 0 , 0 0 0 u n n e c e s s a Ry h o s P i Ta l i z aTi o n s P e R y e a R 2

Potential Additional Prevention if AllUntreated Patients Used Medication

Actual Prevention Based on PatientsTreated with Medication

Deaths and Hospitalizations Prevented 2

Premature Deaths (2001) Hospitalizations forStroke/Heart Attack (2002)

N u m

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0

300

600

900

1200

1500

86

89

833

420

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od o o w , d p .14 mo -o , p o p o wp p y w op o d o o bo w d ; o -

o p d p b ow d o d - d .

Pharmaceutical Marketing Ensures Timely Access to NewStudies, Clinical Data, Dosing In ormation, and Updat-ed Drug Sa ety Pro les.m y p y d

o w d o y o d bo d o op .15 t po : o o y do p y

d o ow bo op o b , yo d o p b o d y d o o o d p b d o .

P o p y p p o d o oo p b d o o p by p o d p y-

w d d pd d dy d p o y d op. t p p d

o o d o p , d p p o p o o . a krc r p y-

y po o d by P rma o d o o : o 90 p o p y y d d p p p o d p- o-d , -

d b o o (F 2).16 t jo y op y d p pp o d o o bo d o , d

d , d p p o (F3).17 P y o o z p p-

w p q o d ypo o d d o xp o o o

.18

P rm t M r t g: o M f t r i rm g Pr r g

i dd o o p dp o o o p o d d ow d bo

w d d d , p p b o p o o

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wo d y y o o o o bo w

o o o o o , o o o wo d

The Majority o U.S. Prescriptions Are or GenericDemonstrating the Role o Factors Other Than Phceutical Marketing.P o pb d- d . no , 2007,

o d o :9 o 10 o q y p b d ds ;19

13 o 15 o q y p b d d

b ;20 d67 p o p p o d. 21

t o ( p o 2000)22 d o p

p y d o do o dd yp o d p

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o o o d o24o w d p

u.s.

Physician Surveys Report Peer-Reviewed Studies,Formularies and Guidelines, Have Greater Infuenc


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Source: KRC Research, Survey o Physicians about Pharmaceutical and Biotech Research Activities and In ormation, Commissioned by PhRMA, March 2008.

P h y s i c i a n s Va l u e T h e w o R k o f P h a R M a c e u Ti c a l a n D b i o Te c h R e s e a R c h c o M P a n y R e P R e s e n Ta Ti Ve s

Relay your reports of any side effects

Provide informationto give to patients

Provide informational presentationsfor physicians and staff

Provide free drug samples

Answer or find out the answersto specific questions you have

Provide information about assistanceprograms for prescription coverage

Provide information aboutthe latest drugs and treatments

Provide informationabout drug interactions

36 % 17% 24%

37%23%28%

23% 23% 42%

17%52%

46% 16% 28%

28%22%42%

35% 25% 35%

21% 95%

95%

92%

90%

89%

88%

87%

77%

21%53%

20%

Often Useful Sometimes UsefulAlways Useful

M o s T P h y s i c i a n s s a y i n f o R M a Ti o n f R o M P h a R M a c e u Ti c a lc o M P an y R e P s i s u P - To - D a Te , u s e f u l , a n D R e l i a b l e

Information is reliable{90%

2%

7%

62%

28%

Information is useful{96%

3%

63%

33%

{Information is up-to-date

97%

3%

41%

56%

Somewhat agree

Somewhat disagree

Strongly disagree

Strongly agree

Source: KRC Research, Survey o Physicians about Pharmaceutical and Biotech Research Activities and In ormation, Commissioned by PhRMA, March 2008.

Figure 2

Figure 3


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Prescribing than Pharmaceutical Company Marketing. P y y o y po y op y o p o o p -

p b d o :i 2002 p y y by Bo o co g o p,54 p o p y po d o

jo p o p b d o . a o oo d d jo p w p (50

p ) d p d (47 p ), wp p 14 p .25

a 2007 p y y by t c o s dy oD D op y d d b o d y : d o

d y o y po p b d o , o -

d d o (67 p ), o o op (43 p ), d p y d o (37 p ) o -w d o o o p o p (13p ).26

i 2008 krc r y, p y po d o w o ow d d xp ,

p p o , p - w d jo -, p d , o d

p , d p o p o p w po (F 4). i d y o

p b d , bo (55 p ) d d p - y (35 p ) d

o y d d o o o p (11 p ).27

Public and Private Payers Strongly Infuence WMedicines Patients Will Receive.P b d p

d p p o b z o q o p 28

t q p d p o o d d w y o o b o o o p d

oo yp y d do o b d d , d

d d d o -p d b d d . a

d d by d p p d b d.29

f a c To R s P h y s i c i a n s c o n s i D e R w h e n P R e s c R i b i n G

Source: KRC Research, Survey o Physicians on Pharmaceutical In ormation, Commissioned by PhRMA, March 2008.

Information from insurance co. & PBM reps

Amount of the co-pay

Prior authorization restrictions

Patients personal opinions

Colleagues & peers

Patients coverage & formularies

Peer-reviewed journals

Clinical practice guidelines

Patients financial status

Information from pharmaceutical co. reps

Clinical knowledge & experience

Patients unique situation

92% 7% 99

99

94%

90%

89%

86%

76%

74%

72%

71%

68%

44%

88% 11%

41%53%

43% 47%

37% 52%

40% 46%

41%35%

63%11%

17% 55%

29% 42%

25% 43%

6% 38%

SomeGreat Deal

Figure 4


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d o p b d o , z o - q y o

po o p b . t d dy o o d - o- o d o d d o p -

, w o d d - o- o dy d d o p d , b o y

b d o b o o y.30 ad d o p 8, o dy d o d p o

o z o o yp p y o p b p o y d p b .31

so o z o q d by d p p o b o p o o p -

b o d p d b d d d :

Formularies . a o y o d pp o d o d b by . D o o -

y b d o (1) o PBm P y & t p - (P&t) co d bo d

d (2) p o PBm o w . D o d o o y o

o d, o d o . t - d b d w

p pp o . i d PBm po o o o o y w p o . Fo , a , d

o o o o y o o x -w p o . O o y o p o d o

d x p y d p - o p bo d o d o -

d o . t d d o p d d p po p d , o y

q d po b y o o - o do o o p d d .32 i , y d

d by d p d o p d oo , d b d

w p pp o .

Tiered Copays . mo d PBm d o -, w d b o d o d o z d o

p o o . g y, o , p d b d d

d . so p b o k F y Fo d o , 2007

p o o d wo w p w33

t p o -o -po p y o d o p o o d

b d p p ,34 o o -p d b35co o y, d , d o 1,

op y, o p p p o p y by po p o o . i 2007,

p o .36 B d d dd, b d o o

o ,37 yp y o 2, w 2006. no -p d b d d , d

d $43 op y.38 B w 2000 d 2007, o wo p w o o

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a body o po oy p

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a 2003 dy New England Journal of Medicin40o d w p oy w d oo o 3- o , bo

d b ( d o d o 3 o w o y wd o 1 d 2. s w

o yp o d d dace b ood p d p o o p p b o

o op o x d . a o yp o d o

p p o op y w o d o o p d o p d b 41


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Prior Authorization . u d p o o z o (Pa) p o , do o o d p b d by p y

p o o z o d .t q p p y o o o j y-

o p d ; b d o o op o d d, d d w o o d .

P o o z o y d p b o d o w pp d. Fo , 2008dy Health Affairs po d m m d d

p o p o o p o o z o d ppy o yp p y o d y d

p b p46, o d -. a m p d p o o z o , o

yp p y o o q Pa d w o o q Pa d d o o -

o y o d p dy o d . a ow o yp p y o , w

, w yp p y o bjo Pa d o bo 40 p b o po y

d o 29 p d po y, w o d

o bj o Pa d. t o d p py d

w zop y d o .

Step Therapy . s p py p o q d p y d o d

b d o d o p47 t , py p o q p

d p , w b d d p opy o d o y p

p o o .

Physician Profiling, Feedback, and Counter-detailing . i d PBm op p o x

p b p , p o d db -d o p o o o 2007 D t d r po , m d o, o o

PBm , d b p o p oy . i dd o o p o d

do d p o o d

T r d c p : imp t M d t u d P t t ad r

n o d d o d p o d o .42 mo o b o ranD d o o d wo d, w ow d o 10 p p b w 2 d 6 p d p d o o d o d p .43 t o o d

o o d w ow o d , wo d od o o o py. . . . Fo o d o , d y d

d d o o , o p z o d y d p

no b y, o y d o p o p pyp d d o p y d/o d d o o d p od o d by

d , o d o p 7, d - o- o d y d d b do o o y b d o b o o y.

i o o d po op y d o y dp b d py, o o p d by d o o p d y ,44 o o w d- oo

ow d o op y . i d, y d op yd o p o d o by o d o d 45


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p oy o g P d c d, p od d d y d p y :

top-p b p y w o dw d o o y. tp y d d o p ,

w q y o obj - o i p o g D u z o

p oj . t p o d d p o po s x s p o o o (sPc)

. t op 50 p b p y o -d p od po o d d

b o (gsr), gDr [ d p], d d p - -w (DaW) p o

.48

u o p y by p o p -, yp o p o o q d o o p y w FDa

o .

Financial Incentives to Physicians and Pharmacists to Pro- mote Therapeutic Interchange and High Generic Use Rates. W p , d PBm

o p y w o p b d o -p dd o w p o d d , yp -

y o p d b d, p - .49 a , p y o o -

d w d o w p o dd o50 o o p b .51

add o y, o d PBm p oy po p y o d o w oppo .52 a -o d o 2008 krc y, p y -

po y d by d p o wo d y p b d o o d ( o

opy o o y p b d). F y- x p d y

d o w o o o y yw p p o . t 44 p po d b -

d o w o o .53 F y, o dPBm y w d p o d -p o d p d b d .54

c

P d p o o oo p y by p o d FDa-

d o o bo w d o w d by p

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o o o o o o o po o p o d od d p b o o

p o o o d d dd .


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16 Ibid.

17 Ibid.

18

Ibid.19 IMS National Prescription Audit Plus.

20 IMS Medicare Watch, February 11, 2008.

21 IMS Press Release, IMS Reports U.S. Prescription Sales Grew 3.8 Percent in2007, to $286.5 Billion, March 12, 2008.

22 R. Frank, The Ongoing Regulation o Generic Drugs,New England Journal of Medicine , November 15, 2007.

23 See also V. Fuhrmans, Doctors Paid to Prescribe Generic Pills,Wall Street Journal , January 24, 2008, B1, reporting on a three month program in 2007 BluCross/Blue Shield o Michigan that paid doctors a total o $2 million ($100 pepatient) or switching patients rom a brand statin to a di erent statins genercopy.

24 P. Danzon, and M. Furukawa, International Prices and Availability o Pharmaticals in 2005, Health Affairs, January/February 2008. Note: share o marketshown here is calculated based on total number o standard units (e.g., numberpills).

25 2002 Boston Consulting Group proprietary survey, n=399.

26 Tu ts Center or the Study o Drug Development, Outlook 2008.

27 KRC Survey, op cit.

28 Pharmacy Bene t Management Institute, Prescription Drug Bene t Costs and Design: 2007 Edition, 2007, p. 29. Charlie Baker, President and CEO o Har-vard Pilgrim Health Care, DrugsNot the Cost Problem, Harvard Pilgrim HeCare, www.letstalkhealthcare.org/prescription-drugs/drugs-not-the-cost-problem,accessed on June 30, 2008.

29 B. Landon, Incentive Formularies and Changes in Prescription Drug SpendingThe American Journal of Managed Care , June 2007.

30 M. Wosinska, Just What the Patient Ordered? Direct-to-Consumer Advertisingand the Demand or Pharmaceutical Products,HBS Marketing Research Paper No. 02-04 , (October 2002). http://papers.ssrn.com/sol3/papers.c m?abstract_id=347005.

31 S. Soumerai et al., Use o Atypical Antipsychotic Drugs or Schizophrenia InMaine Medicaid Following a Policy Change,Health Affairs, April 1, 2008.

32 Aetna Pre erred Drug List FAQs,http://www.aetna.com/help/faq_formulary.html .

33 The Kaiser Family Foundation and Health Research Educational Trust, EmploHealth Bene ts, 2007 Summary o Findings.

34 T.S. Rector et al., E ect o Tiered Prescription Copayments on the Use o PBrand Medicines,Medical Care , March 2003.

e n d n o t e s

1 See, or example: T. Higashi et al., The Quality o Pharmacologic Care or Vulner-

able Elder Patients,Annals of Internal Medicine , May 4, 2004; K.Gilberg et al.,Analysis o Medication Use Patterns: Apparent Overuse o Antibiotics and Under-use o Prescription Drugs or Asthma, Depression, and CHF, Journal of Managed Care Pharmacy , May/June, 2003; J. T. Harrington, Hip Fracture Patients Are NotTreated or Osteoporosis: A Call to Action,Arthritis & Rheumatism, 2002; and J.Ma, National Trends in Statin Use by Coronary Heart Disease Risk Category,Public Library of Science-Medicine , May 2005.

2 C. Len ant, Clinical Research to Clinical PracticeLost in Translation?,New England Journal of Medicine , August 28, 2003.

3 D. Cutler and M. McClellan, Is Technological Change in Medicine Worth It?Health Affairs, September/October 2001.

4 Mental Health America, Fact Sheet: Depression: What You Need To Know,

http://www.mentalhealthamerica.net/go/information/get-info/depression/ depression-what-you-need-to-know/depression-what-you-need-to-know#end , ac-cessed June 17, 2008.

5 T. Higashi et al., The Quality o Pharmacologic Care or Vulnerable Elder Pa-tients,Annals of Internal Medicine , May 4, 2004.

6 K.Gilberg et al., Analysis o Medication Use Patterns: Apparent Overuse oAntibiotics and Underuse o Prescription Drugs or Asthma, Depression, and CHF,

Journal of Managed Care Pharmacy , May/June, 2003.

7 J. T. Harrington, Hip Fracture Patients Are Not Treated or Osteoporosis: A Call toAction,Arthritis & Rheumatism, 2002.

8 J. Ma, National Trends in Statin Use by Coronary Heart Disease Risk Category,Public Library of Science-Medicine , May 2005.

9 R. Dubois et al., Growth in the Use o Lipid-Lowering Therapies: Are we Targetingthe Right Patients,The American Journal of Managed Care , October 2002.

10 M. Cabana et al., Why Dont Physicians Follow Clinical Practice Guidelines,A Framework or Improvement, Journal of the American Medical Association,October 22, 1999.

11 PhRMA analysis o the National Health and Nutrition Examination Survey 2003-2004, Centers or Disease Control and Prevention.

12 Centers or Disease Control and Prevention, Chronic Disease Overview,http:// www.cdc.gov/nccdphp/overview.htm

13 D. Cutler, et al., The Value o Antihypertensive Drugs: A Perspective on MedicalInnovation,Health Affairs, January/February 2007.

14 K. Hitchens., Diabetes Care Closing the Gap Between Standards and Practice,Special Supplement toDrug Topics, October 2002: p. 2-27.

15 KRC Research, Survey o Physicians about Pharmaceutical and Biotech ResearchActivities and In ormation, Commissioned by PhRMA, March 2008.


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also Kaiser Commission on Medicaid and the Uninsured, Case Study: MichigaMedicaid Prescription Drug Bene t, January 2003 and P. Cunningham, MedicCost Containment and Access to Prescription Drugs,Health Affairs, May/June2005.

47 B. Falik, The Academy o Managed Care Pharmacys Concepts in ManagedCare Pharmacy: Prior Authorization and the Formulary Exception Process, Journaof Managed Care Pharmacy , May 2005, p. 359.

48 Medco Health Solutions,Drug Trend Report , 2007, Volume 9, Page 72.

49 Aetna Pharmacy, Explore Alternatives.http://www.aetnapharmacy.com/AP/ ihtAP/r.WSIHW000/st.51004/t.35599.html. Accessed April 22, 2008 andCigna, Weighing the Alternatives. http://www.cigna.com/our_plans/pharmacy/alternatives.html. Accessed April 22, 2008.

50 See V. Fuhrmans, Doctors Paid to Prescribe Generic Pills,Wall Street Journal , January 24, 2008, B1, and S. Wallack, D.Weinberg et al. Health Plans Strate-gies to Control Prescription Drug Spending,Health Affairs, November/December2004.

51 See J. Carroll, Should Plans Pay Physicians to Switch Patients to Generics?,Managed Care , March 2008, re erencing a pilot program under which ExcelluBlueCross BlueShield o ered our physician groups an increased rate or stypes o o ce visits when they increased their generic ll rates by 5 percent

52 D. Gesenway Drug Switching: Lowering costs versus adverse interactions,potential errors, American College o Physicians.http://www.acponline.org/ clinical_information/journals_publications/acp_internist/jul-aug00/ drugswitchinhtm. Accessed April 22, 2008 and H. L. Lipton et al. Managing the PharmacyBene t in Medicare HMOs: What do we really know?Health Affairs, March/April 2000.

53 KRC Research, Survey o Physicians about Pharmaceutical and Biotech ReseaActivities and In ormation, Commissioned by PhRMA, March 2008.

54 S. Wallack op. cit.

35 See P. Landsman et al., Impact o 3-Tier Pharmacy Bene t Design and IncreasedConsumer Cost-sharing on Drug Utilization,The American Journal of Managed Care , October 2005 and T.S. Rector et al., E ect o Tiered Prescription Copay-ments on the Use o Pre erred Brand Medication,Medical Care , March 2003,

which show that increases in copayments or medications infuence the types omedications chosen.

36 The Kaiser Family Foundation and Health Research Educational Trust, EmployerHealth Bene ts, 2007 Summary o Findings.

37 Aetna Pre erred Drug List FAQs,http://www.aetna.com/help/faq_formulary.html .

38 Ibid .

39 The Kaiser Family Foundation and Health Research Educational Trust, EmployerHealth Bene ts, 2007 Summary o Findings.

40 H. Huskamp et al., The E ect o Incentive-Based Formularies on Prescription-Drug Utilization and Spending.New England Journal of Medicine , December 4,2003. Much smaller changes were ound in switching and stopping use o statinsin a comparison group that maintained a 3-tier ormulary throughout the periodstudied.

41 T.S. Rector et al., E ect o Tiered Prescription Copayments on the Use o Pre erredBrand Medications,Medical Care , March 2003.

42 See, or example: H. Huskamp et al., The E ect o Incentive-Based Formularies onPrescription-Drug Utilization and Spending.New England Journal of Medicine ,December 4, 2003 (Much smaller changes were ound in switching and stoppinguse o statins in a comparison group that maintained a 3-tier ormulary throughoutthe period studied.); T.S. Rector et al., E ect o Tiered Prescription Copayments onthe Use o Pre erred Brand Medications,Medical Care , March 2003; and E.R.Cox et al., Impact o Patient and Plan Design Factors on Switching to Pre erredStatin Therapy,Annals of Pharmacotherapy , Dec. 2007.

43 D. Goldman et al., Prescription Drug Cost Sharing: Associations with Medicationand Medical Utilization and Spending and Health, Journal of the American Medi- cal Association, July 4, 2007.

44 See, or example, D. P. Goldman, Pharmacy Bene ts and the Use o Drugs bythe Chronically Ill, Journal of the American Medical Association, May 19, 2004;A. Dor and W. Encinosa, Does Cost Sharing A ect Compliance? The Case oPrescription Drugs, National Bureau o Economic Research Working Paper No.w10738 , August 2004; D. Taira et al, Copayment Level and Compliance withAntihypertensive Medication: Analysis and Policy Implications or ManagedCare, The American Journal of Managed Care , November 2006; D.W. Roblinet al., E ect o Cost-Sharing on Oral Hypoglycemic Use in Five Managed CareOrganizations: How Much is Too Much?Medical Care , October 2005; and H.Huskamp et al., The E ect o Incentive-Based Formularies on Prescription-DrugUtilization and Spending.New England Journal of Medicine , December 4, 2003.

45 V. Furhmans, New Tack on Copays: Cutting ThemEmployers, Insurers Bet ThatCovering More o the Cost o Drugs Can Save Money Over the Long Term orChronic Conditions,The Wall Street Journal , May 8, 2007. M. Freudenheim, ToSave Later, Employers O er Free Drugs Now, The New York Times, February 21,2007.

46 S. Soumerai et al., Use o Atypical Antipsychotic Drugs or Schizophrenia InMaine Medicaid Following a Policy Change,Health Affairs, April 1, 2008. See


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