Fewer drug rep visits lead to lower drug costs

Physicians prescribed fewer drugs that were being promoted by sales reps when academic medical centers implemented policies restricting visits by those salespeople, a new study found.

Pharmaceutical companies spend billions of dollars a year to promote medications to doctors during sales visits and events that may include gifts such as meals and free samples, a practice known as drug detailing.

High drugs costs, driven mostly by high levels of prescriptions for brand name drugs over less expensive ones have led hospitals, lawmakers and consumers to ask for relief.

In response, some U.S. academic medical centers enacted policies restricting detailing between 2006 and 2012, which limited the access salespeople had to physicians. It also limited the number of gifts doctors could receive.

Over that period, the market share of detailed drugs prescribed by academic medical centers dropped 8.7% relative to the level prior to enacting the policy changes, according to the study published in JAMA Tuesday. Prescriptions shifted away from detailed drugs largely toward generic ones, the study found. Prior to the policy changes, detailed drugs held an average of 19.3% of the market share.

"There has long been concern that drug marketing to physicians might influence their prescribing, including — and maybe especially — for psychiatric drugs," said one of the study coauthors Dr. Michael Schoenbaum, the senior advisor for mental health services, epidemiology and economics for the Division of Services and Intervention Research at National Institute of Mental Health, which supported the study. According to the study, there is little research on the definitive implications of drug detailing—mostly because the formidable pharmaceutical industry prevents it from coming to light.

And that's not the only place drugmakers spend money. The pharmaceutical industry spent more than $24 billion on marketing directly to physicians in 2012 compared to $3 billion a year to consumers, according to a study published that year in the Pew Charitable Trusts. About $15 billion of that was face-to-face selling and around $6 billion was in free samples. As of 2012, approximately 72,000 pharmaceutical sales representatives were employed in the country. There were 916,000 licensed physicians.

Providing free samples to healthcare professionals led to significant increases in new prescriptions for the sampled drugs, per the Pew study. While drug companies argue that the samples are especially important to patients who couldn't afford them otherwise, research shows that most are given to insured patients.

The decline in promoted drug prescriptions was more drastic following the implementation of stricter policies that includes bans on salespeople in patient care areas, requirements for salesperson registration and training, and penalties for salespeople and physicians for violating the policies.

Researchers studied 19 centers that implemented the new policies, including 2,126 physicians who practiced in California, Illinois, Massachusetts, New York and Pennsylvania, compared to a control group of 24,593 physicians. They analyzed more than 16 million prescriptions of eight major drug classes: lipid-lowering drugs, gastroesophageal reflux disease drugs, antidiabetic agents, antihypertensive drugs, sleep aids, attention deficit hyperactivity disorder drugs, antidepressant drugs and antipsychotic drugs.

"Important next steps include assessing the economic impact of these policies and whether they affect patients' clinical outcomes," Schoenbaum said.

Soaring drug prices have taken a significant chunk out of hospitals' bottom lines. Annual inpatient drug spending was up an average of 23.4% between 2013 and 2015, and 38.7% on a per admission basis, according to a 2016 study from America's biggest hospital lobbies.