May 9, 2017

When hospitals limit drug rep meetings, generic drugs get more prescriptions, study finds

Daily Briefing

    Policies that limited physician meetings with pharmaceutical sales representatives correlated with reduced prescribing of brand-name medications, according to a study published last Tuesday in JAMA.

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    Study details

    For the study, researchers from several institutions—including the National Institute of Mental Health, CVS Caremark, Carnegie Mellon University, Cornell University, and the University of California-Los Angeles (UCLA)—examined physician prescribing behaviors by analyzing data collected between 2006 and 2012 from 19 academic medical centers in California, Illinois, Massachusetts, Pennsylvania, and New York, which have implemented policies to limit drug marketing practices. The researchers compared the prescribing behaviors of 2,126 doctors at those medical centers with the prescribing behaviors of 24,593 physicians not subject to marketing practice limits.

    The researchers focused on prescribing data for eight major drug classes:

    • Antidepressant drugs;
    • Antidiabetic agents;
    • Antipsychotic drugs;
    • Antihypertensive drugs;
    • Attention deficit hyperactivity disorder drugs;
    • Gastroesophageal reflux disease drugs;
    • Lipid-lowering drugs; and
    • Sleep aids. 

    The researchers selected those classes because each class included drugs that were highly marketed by sales representatives, as well as at least one widely prescribed drug that was not marketed by sales representatives. According to the data, at least 2,000 pharmaceutical company salespeople were assigned to promote treatments in those eight drug classes during the study period.

    Findings

    According to the study, physicians prescribed fewer brand-name drugs and more generic drugs when academic medical centers implemented policies that restricted physician visits with pharmaceutical sales representatives.

    Specifically, the researchers found that such policies were associated with a 1.67 percentage-point decrease in market share for drugs promoted by sales representatives, falling from 19.3 percent to about 17 percent. Meanwhile, the market share of non-promoted drugs rose by 0.84 percentage points after the policies took effect, increasing from 14.2 percent market share to about 15 percent.

    Further, the researchers found that institutions with stricter policies—including an enforcement component, restricting sales representatives' access to their facilities, and regulating gifts to doctors— appeared to have more significant declines in prescribing of such drugs.  

    Discussion

    Ian Larkin, a researcher on the study from UCLA's Anderson School of Management, said the "findings suggest that the organizational level can and does make an important difference" in prescribing.

    In an accompanying editorial, Colette DeJong and Adams Dudley—researchers from the University of California-San Francisco's Center for Healthcare Value, who were not involved in the study—called on physicians to consider ways to learn about drugs that do not involve sales representatives.

    They wrote that there are "feasible alternatives" to being informed about drugs from industry that "are largely untested in the United States," and urged physicians "to come together to consider these alternatives, generate evidence about their effectiveness, and move the health care system toward solutions that lower costs for patients and minimize (conflicts of interests)" (Kacik, Modern Healthcare, 5/3; Ornstein, "Shots," ProPublica/NPR, 5/2; Seaman, Reuters, 5/2; Larkin et al., JAMA, May 2017; DeJong/Dudley, JAMA, May 2017).

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    As the number of medications rises, so does the opportunity for medication errors, such as incorrect dosages, drug interactions, and serious side effects. By some estimates, the U.S. spends as much money correcting these medications problems as we do on the drugs themselves.

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