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Health Column: Physicians and drug reps, and why you should care!

Phil Mohler, M.D.
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist

The next time you visit your physician, look around the waiting room. Are there attractive, well-dressed, smiling men and women lugging large briefcases? If so, your doc may be getting a visit from a pharmaceutical company salesperson (i.e. drug rep). Why should you care?

Fifteen years ago, we studied the self-reported behaviors of local physicians with respect to whether they consulted with drug reps and whether they took the reps’ sample drugs. Subsequently, we compared Rocky Mountain Health Plans physician pharmacy data — average cost per prescription by physician and average number of prescriptions per patient per doc.

Here’s what we found. There was a direct relationship between the number of drug reps a physician saw and how many prescriptions that doc wrote and how much those prescriptions cost. On average, both costs per patient and the number of prescriptions per patient were 10 percent lower for physicians who saw no drug reps compared with those that saw any drug reps. Physicians who accepted drug samples (remember these are new, high-priced products) and dispensed them to their patients generated higher pharmacy costs for their patients. And the more samples they dispensed, the higher the costs went. Subsequently much larger, more sophisticated studies in the U.S. repeatedly have shown the same phenomena — interacting with Big Pharma drives up pharmacy costs.



In our study, as in others, physicians who see drug reps believe that these sales talks had little or no effect on their own prescribing habits, but moderate to marked effect on the prescribing habits of their colleagues. Finally, 66 out of the 71 physicians in our study believed their own prescribing costs were below the average in our community. (And we all finished in the top 10 percent of our medical school classes.)

If this message has a physician-bashing flavor, look on these facts. Overall our physicians are excellent stewards of pharmaceutical costs. Mesa County physicians have the highest generic prescription rate in the state of Colorado. Over the last 15 years, more and more physicians in our community are opting not to see drug reps and not take their sample drugs.



HOW TO BE AN EFFECTIVE PURCHASER OF DRUGS

Be an active participant! Recognize that you have a partnership with your physician, who often directs how your health care dollars will be spent. Ask your doc about what your prescription will cost, where to buy it and whether it is really necessary. If it is a brand-name drug, is there a generic product that will work as well? Remember to “shop around” for the best deals on your medications. Calling a few pharmacies can generate big savings. It’s easy to switch pharmacies for all your medications or just a “one-time” drug where you can get a better deal.

The opinions expressed are mine and may not reflect those of Rocky Mountain Health Plans or Primary Care Partners.

GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at pjmohler@bresnan.net.


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