The Physician-Pharma Relationship

DR. AMIT B. NIKOSE PRODUCT MANAGER CIPLA LTD.

The Physician-Pharma Relationship

Is very old and very close But are the goals of pharmaceutical companies and medicine the same?

Promotion includes

Detailing Meetings and events (dinner meetings, CME, rounds, symposia) Publications (symposia, monographs, supplements, throwaways) Advertising and reprints Direct mail, e-detailing

The costs of promotion

In 2004, total promotion cost for Rx drugs was almost $30 billion About $7 billion spent on detailing NIH budget FY 2008 is $29 billion* FDA budget FY 2008 is $2 billion**

West D. Changing lanes. Pharm Exec. 2005 May;25(5):154-162. Full text *NIH summary of the FY 2008 presidents budget, 2007 Feb 5. Summary **Summary of FDAs FY 2008 budget. Summary

Promoting the profitable

There are more than 10,000 drugs in the Indian pharmaceutical market More than half of promotional expenditures are concentrated on the top-selling 50 drugs*
*Ma J et al. Clin Ther 2003;25(5):1503-17. Abstract

New drugs are not necessarily better drugs

Most new drugs are me-too drugs, or combinations of old drugs In general, generic drugs are safer than branded drugs simply because more information is available about them

Doctors are too smart to be bought by a slice of pizza

Studies consistently show that promotion increases prescribing* Studies consistently show that physicians do not believe that promotion affects prescribing**

*Chren MM and Landefeld CSl. JAMA 1994 Mar 2;271(9):684-9. Abstract Lurie N et al. J Gen Int Med 1990;5(3):240-243. Abstract Wazana A. JAMA 2000 Jan 19;283(3):373-80. Abstract **Sigworth SK et al. JAMA. 2001 Sept 5;286(9):1024-5. Abstract McKinney WP et al. JAMA 1990 Oct 3;264(13):1693-7. Abstract

Detailing

In 2005, there were about 600,000 doctors and about 100,000 drug reps in the India Actual ratio about 1 rep per 2.5 targeted docs* Targeted docs are high-prescribers, or docs who control market share
*Goldberg M et. al. Pharm Exec. 2004 Jan 1;24:40-5. Abstract

The AMA Physician Masterfile

Contains demographic data that the AMA has sold to industry continuously since the 1940s* In 2005, licensing Masterfile information and other database product sales provided about 16% ($44 million) of the AMAs revenue**
*Greene JA. Ann Int Med. 2007 May 15;146:742-8. Full text **Steinbrook R. NEJM. 2006 Jun 29;354(26):2745-7. Abstract

AMAs Prescription Data Restriction Plan (PDRP)

Few physicians know about it < 1% of doctors have signed up "Just giving them an option [to opt-out] alleviates their concerns," explained the AMAs senior VP of publishing and business services to Pharmaceutical Executive
Herskovits B. Pharm Exec Direct. 2006 Jul 19. Full text

AMAs Opt-out plan

The restrictions do not apply to

(a) deciles at the market or therapeutic class level (b) segmented data that are not likely to reveal the actual or estimated activity of an individual physician, or (c) data on products ordered by physicians from pharmaceutical companies.
Musacchio RA and Hunkler RJ. Pharm Exec 2006 May 1. Full text

What Medical Reps cost

Average annual income for a drug rep is $81,700* Per rep per annum, pharma spends $150,000 ( primary care) $330,000 (specialty) Sales force costs are 5% - 8% of revenue**
**Niles S. Med Ad News. 2005 May;24(5):1-4.

*Goldberg M and Davenport B. Pharm Exec. 2005 Jan 1;25(1): 70. Full text

Facts for medical reps

During training, I was told, when youre out to dinner with a doctor, The physician is eating with a friend. You are eating with a client.

Shahram Ahari*

The essence of pharmaceutical giftingis bribes that arent considered bribes.

Michael Oldani

You are absolutely buying love.

James Reidy
*Fugh-Berman A and Ahari S. PLoS Med. 2007 Apr 24;4(4):e150. Full text Elliott C. Atlantic Monthly. 2006 Apr;297(3):82-93. Full text

I dont listen to the reps

<1 minute of a sales reps interaction with a doctor results in a 16% prescribing change
3 minutes with a doctor results in a 52% prescribing change
Prounis C. Best foot forward. Communique, vol 7. Full text (also downloadable pdf)

I only see reps for the samples

Why docs like samples

Start treatment immediately Test tolerance to a new drug Reduce the total cost of a Rx Provide free medication to those who cant afford it

Why drug companies like samples

Increases new starts on a new drug Encourages switches from other drugs Patients usually stay on the sampled drug Increases prescriptions of the most expensive, most promoted drugs

The real purpose of samples

Gain access to physicians Habituate physicians to prescribing targeted drugs Increase goodwill by enabling doctors to give gifts to patients Serve as unacknowledged gifts to physicians and staff

Samples are a marketing tool

the manufacturer needs to figure out the right amount of samples the rep has to drop off in order to maximize the number of paid prescriptions written.

Tsang J and Rudychev I. Medical Marketing & Media. 2006 Feb;41(2):52-8.

Meetings and events

Nearly 30 percent of physicians who attend association meetings refuse to see reps in their officea no-see strategy is critical for companies to overcome
Rehal D. Successful Product Managers Handbook. Pharm Exec. 2007 Mar 1;7:8-15. Full text

Pharma controls CME

In 2006, over $2.3 billion dollars was spent on CME More than half of this came from pharmaceutical manufacturers Medical Education and Communication Companies (MECs) 76% of income is from firms that manufacture FDAregulated products Medical schools 62% of CME income to medical schools comes from pharma (ACCME)
ACCME Annual Report Data 2006, Table 7. 2007 Jul 6. Report

Advertising in medical journals

More than 95% of JAMA ads are for Rx drugs 5 of 6 physician organizations raised at least 10% of annual revenue from ads in affiliated medical journals Pharma companies also purchase sponsored subscriptions And are the largest purchaser of reprints
Fugh-Berman A, Alladin K, Chow J. PLoS Med. 2006;3(6):e130. Full text

I Never Read the Ads

Correct message retention by media mix

No promotion 14% Detail only 21% Detail and print [ads] 36% Detail and sales aid 33% Detail and print and sales aid 44%

Paul CM. Medical Marketing & Media. 2006 Dec;41(12):60-2. Full text

What about R&D costs?

Pharma spends 2-3 times as much on marketing as it does on research

Edwards J. Brandweek. 2005 Feb 7; ;46(6):24-6.

Is promotion worth it?

In 2006, the ten best-selling global pharma brands made $53.5 billion* In 2001, the average return on investment per dollar spent on promotion was $12.70**
*Robins R. Successful Product Managers Handbook. Pharm Exec 2007 Mar 1;7:38-41.
**Niles S. Med Ad News 2004 Mar;23(3):1

Thank you

References