Pharmaceutical companies take lots of hits these days. Hot-button stories, like those about costly Epipens, or the outlandish moves of a pharma-executive-wannabe-turned-felon like Martin Shkreli, have put the approval rating of drug makers somewhere around that of members of Congress. The most visible member of the pharmaceutical industry for most people is the pharmaceutical salesperson, aka drug rep, the person often seen dragging a satchel around medical office buildings. Ask someone what drug reps actually do, and most responses revolve around providing lunches for doctors’ offices, and dropping off drug samples. Outside the circle of doctors, nurses, and office staff, few get to see reps doing what they are actually paid to do.
Doctors, Physician Assistants (PAs) and Advanced Practice Nurses (APNs) deal with a wide variety of illnesses and conditions every day. Many of these conditions are treated with medication, and in most instances, there are two or more choices available. Some treatment regimens contain the option to choose from different classes of drugs, each employing a different mechanism of action. For a condition as common as high blood pressure, there are literally dozens and dozens of agents available, from several different classes, and two or more drugs from different classes may be combined to achieve a patient’s targeted BP goal. Each class of drugs, and even drugs from different manufacturers within the same class, typically have different clinical trial data supporting their use, different dosing schedules, unique side effect profiles, and varying degrees of insurance coverage.
Sound confusing? It definitely is, and expecting prescribers to remember all those variables is nigh unto impossible. There are programs available for electronic devices that can help, but it’s hard to ask a software program a question when one arises. That’s where drug reps come in.
The majority of reps are responsible for at most three or four products, so they have a far easier time keeping up with the latest information, including new clinical trial data, new indications, or FDA-recommended revisions to existing precribing information. They’ll be knowledgeable re which type of patient clinical trials have shown to be best served by their product, including precautions re any interactions their products have with other commonly prescribed medications. They will also be aware of the extent of insurance coverage for their products, including Medicare Part D and Medicaid, an important factor in this age of complicated, and often changeable formularies, with their exclusions, prior authorizations, and quantity limits.
Drug reps supply offices with Direct-to-Consumer rebates and discount cards, patient education materials, and application forms that allow patients in financial need to receive their meds at low or zero cost. In cases where a patient experiences a severe or unusual side effect, it is often the drug rep who alerts their company’s medical response team, and reports the incident to the FDA as required.
In past years, drug maker’s sales representatives have sometimes abused their privileges. They deviated from their original purpose of education, and flooded doctors’ offices with cheesy giveaways, free meals, and canned promotional messages. In those instances, reps took time away from patient care, brought little usable information to their customers, and generally made themselves unwelcome. A wave of offices closed themselves off to visitors, ultimately resulting in a substantial reduction in the number of reps employed by manufacturers. Accountability measures recently put into place require pharma companies to report how just much money is spent per attendee at meals delivered to medical offices. Most companies no longer provide promotional supplies like pens, clipboards, and notepads to their reps for distribution to customers. Educational seminars and local speaker programs are now administered by impartial third parties, and speakers must complete training to ensure lectures remain focused on data approved by the FDA and consistent with the product’s prescribing information.
To be totally fair, some limits placed on drug reps’ interactions with their customers resulted not from bad behavior, but from the consolidation of private physician practices into large, hospital-based medical groups. These large groups can be openly hostile to the idea of drug reps regularly interacting with their physicians, especially if they believe reps might violate medical group policies re what type of information can be distributed. Moves by large groups to restrict drug reps intensified as hospitals began to exert ever-greater control over their member prescribers. Some groups go so far as to only allow dropping of samples, with virtually no interaction allowed beyond witnessing a signature for those samples delivered.
More recent times have seen companies emphasize the concept of delivering value to customers, where reps rededicate themselves to helping practices better serve their patients. Representatives work to tailor their approach to one that recognizes each practice’s unique patient population, addresses cutrent issues, like the affordability of, and access to, medications, and bases interactions with prescribers on the needs of the practice, not the needs of the rep or their company. In the long run, if the response to the excesses of the past leads to a more valuable relationship between prescribers and reps, it will be worth the upheaval. The real question is how best to get new or updated information to doctors and other prescribers who face an increased patient load, additional administrative duties via the requirements of maintaining Electronic Health Records (EHR), and meeting accounting requirements established by their medical group employer.
Perhaps the best example of how drug reps can provide a service to their customers came from a cardiologist in the St Louis area. While spending the day observing the doctor’s evaluation of patients suffering from heart disease, I asked him what drug reps could do to be of of utmost service to his practice. He pointed to a stack of literature piled high on his desk. The stack consisted of medical journals, pharmacy newsletters, and package insert pages from new medications. He told me that keeping current on new data was a huge challenge in his busy practice, and that he relied on pharma reps to bring him any info that reflected updates or revisions to the dosing, safety profile, or accessibility of the medications he most commonly prescribed, or were newly approved. He also asked that “his reps” keep themselves current and accessible, in case a question arose or a problem developed with any of the products. In short, the doctor wanted his reps to be a timely resource he could count on for support. As the doctor related, “In order to convince a patient to take a prescribed medication, I have to sell them on the risk-to-benefit ratio of the treatment. I need accurate, no-nonsense information in order to do that. Don’t give me a sales pitch, give me the facts.” Accepting that responsibility is what differentiates good drug reps from mere sample droppers. It’s also a way to ensure that when a doctor makes the decision to put pen to prescription pad, or clicks the send button, they’re doing so with the best data available.
Raymond T Kyle
Kyle Policy Partners