Truth is the Best Medicine...Get the facts on
prescription drug costs
Myth #6: I can rely on my doctors always to
prescribe the best drug.
Fact: Drug marketing and promotions influence
prescribing behavior.
The drug industry spends $12 billion a year
marketing its prescription medications to doctors,
with the expectation that its investment will pay
off in increased prescriptions and sales. [1] Drug
makers send sales representatives to doctors’
offices and hospitals to “educate” doctors about
their products, providing free meals, drug samples
and gifts. [2] Companies provide free samples of the
newest and most expensive drugs with the expectation
that doctors will start patients on a treatment
regimen with the samples and continue prescribing
these expensive brand-name medicines rather than
cheaper generics. [3] Studies have demonstrated that
such marketing strategies influence which drugs
doctors prescribe, often choosing an expensive
brand-name drug over a generic competitor.
[4] Companies frequently begin promoting new drugs
to doctors before they are even approved, sponsoring
continuing-education courses and ghostwriting
medical journal articles, to fuel prescriptions—and
thus profits—when the drugs arrive on the market.
[5] Kaiser Permanente, a managed care organization,
bans gift-taking from drug companies; its doctors
prescribe heavily marketed drugs far less frequently
than most other doctors. [6]
Fact: Marketing to doctors promotes expensive and
often unnecessary prescriptions.
Doctors with frequent contact with the drug industry
(such as accepting free samples and gifts, attending
conferences and courses sponsored by drug companies,
or meeting with sales representatives) are more
likely to write higher numbers of prescriptions and
to prescribe brand-name drugs rather than generic
equivalents. [7] They are also less likely to
prescribe based on clinical evidence. [8]
Additionally, about a third of doctors who write
guidelines and recommendations for drug treatments
have ties to the pharmaceutical industry. [9] The
National Kidney Foundation issued guidelines for
anemia treatment that encourage dosages of the drug
Epogen exceeding FDA-recommended levels, posing
serious risks for heart attack and stroke in
patients. Amgen, the drug’s manufacturer, sponsored
the guidelines and contributed $4 million to the
foundation in 2005. [10]
Fact: Formulary management encourages prescriptions
based on necessity, not promotions.
A comprehensive, evidence-based formulary provides
sound guidance for doctors in prescribing effective
drug regimens. A good model can be found in the
national formulary under the Department of Veterans
Affairs (VA), which keeps doctors up-to-date on
available drug treatments—a better source than
biased materials provided by drug companies—and
helps relieve some of the pressures advertising puts
on doctors to prescribe certain medicines. [11] The
VA system has been able to achieve high rates of
formulary compliance among doctors and significantly
reduced drug prices. [12] State Medicaid programs’
Preferred Drug Lists (PDLs) similarly guide
prescribers toward effective treatments at low
costs. When a particular drug on the formulary is
not right for a patient, doctors are able to easily
and efficiently obtain prior authorization, giving
patients access to prescribed medicines. [13]
1 “Doctors and Drug Makers: A Move to
End Cozy Ties,”
New York Times,
February 12, 2007.
(http://www.nytimes.com/2007/02/12/business/12drug.html)
2 “Physicians and the Pharmaceutical
Industry: Is a Gift Ever Just a Gift?” Journal of the American Medical Association, January 19,
2000. (http://jama.ama-assn.org/cgi/content/full/283/3/373?ijkey=26cce76d265c0147812cc7fcee0067bfe76bace7)
3 “Doctors and Drug Makers: A Move to
End Cozy Ties,”
New York Times,
February 12, 2007.
(http://www.nytimes.com/2007/02/12/business/12drug.html)
4 “Do drug samples influence resident
prescribing behavior? A randomized trial,” American
Journal of Medicine, August 2005. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16084181&query_hl=3)
5 “Madison Ave. Has Growing Role In
the Business of Drug Research,”
New York Times, November 22, 2002. (http://query.nytimes.com/gst/fullpage.html?sec=health&res=9F0DEEDF1239F931A15752C1A9649C8B63)
6 “Seducing the Medical Profession,”
New York Times, Feburary 2, 2006.(http://www.nytimes.com/2006/02/02/opinion/02thu3.html?ex=1296536400&en=48b4bb73fd10a999&ei=5088&partner=rssnyt&emc=rss)
8 “The Company We Keep: Why
Physicians Should Refuse to See Pharmaceutical
Representatives,” Annals of Family Medicine, January
2005. (http://www.annfammed.org/cgi/content/full/3/1/82#R7)
9 “Doctors who write guidelines often
have ties to the drug industry,” British Medical
Journal, October 2005. (http://www.bmj.com/cgi/content/full/331/7523/982-a).
See “Cash interests taint drug advice,” Nature,
October 2005.
10 “Treatment of Anemia Questioned,”
New York Times,
November 30, 2006. (http://www.nytimes.com/2006/11/30/health/30drug.html?ex=1171602000&en=9b2f45380388406d&ei=5070)
11“VA Drug Formulary: Better
Oversight Is Required, but Veterans Are Getting
Needed Drugs,” Government Accountability Office,
January 2001. (http://www.gao.gov/new.items/d01183.pdf)
12 “The Impact of a National
Prescription Drug Formulary on Prices, Market Share,
and Spending: Lessons for Medicare?” Health Affairs,
May/June 2003. (http://content.healthaffairs.org/cgi/content/full/22/3/149)
13 “State Medicaid Programs Lead the
Way on Negotiation of Drug Prices,” Project on
Information Just and Intellectual Property Rights,
National Legislative Association on Prescription
Drugs, and Forum on Democracy and Trade, January 11,
2007.(http://www.wcl.american.edu/pijip/documents/DrugPriceNegFactSheet.pdf?rd=1)