GUEST COMMENTARY

High-Prescribing PAs and NPs: A Market Too Big to Ignore
By David Mittman, PA

I have been a licensed PA for over 30 years. I began practicing in late 1975 and just one year later PAs started prescribing legally in NY State. My early days were spent in family practice where I wrote an average of 25 to 30 prescriptions a day. Some days I easily wrote over 50. The local pharmaceutical salespeople got to know me and how much I prescribed, and the smart ones spent time detailing me.

My Squibb rep taught me about Capoten, and then I taught many of the family physicians I worked with about ACE inhibitors. He later told me my medical group was one of the largest Capoten prescribers in the state. My Roerig (Pfizer) rep won a sales award partly because I was the number-one Spectrobid prescriber in Brooklyn. I learned much from my reps and considered many of them friends. But when it came time to sample, they wrote down the name of the physician I worked with, which I did not like but knew was the only way I would get sampled.

To be sure, I love this industry. I also love my profession. Because of this love, I continue to teach the value of each group to its individual stakeholders. Over the years, PAs and NPs have not been afforded the same attention as physicians have from the pharmaceutical industry. In my humble opinion, now may be a great time to take another look at these prescribers.

In 1983, I fell into a new career in medical publishing and quickly became an industry expert in PAs and later NPs. As my years in medical communications grew, so did my understanding that PAs and NPs were a “hard sell” to pharmaceutical marketers. Our professions had names like “assistant” and “nurse” and, as I was told many times by a number of marketing people, “The doctor tells you all what to write anyway.” Those who never “carried the bag” often thought we were exaggerating the fact that these clinicians could and did prescribe and make their own therapeutic decisions. When I met product managers who had encountered PAs and NPs in the field, they universally said we were great for their territories. They observed that we were willing to listen, open to learning, and generally were great prescribers.

As I learned more, I realized that many of the “experts” that the pharma companies hired for their high-prescriber lists did not ask if the physicians on those lists were working with NPs or PAs. Also I learned that the pharmacist tended to put the physician's name down on the “official forms” because there was not even a place to note an NP or PA, and the AMA database did not include us anyway. Most Rx pads had the physician’s name first and then the PA’s and NP's way down at the bottom.

Things are somewhat better today, but not where I thought they would be by now. There is still skepticism because many of the people who track prescriptions still turn their heads and close their eyes. Their “high-prescribing physicians” may have two PAs and three NPs in the office who do most of the prescribing. Industry publications rarely if ever point out that there are other prescribers and use the word “doctors” to mean prescribers. Funny, my prescription pad changed 20 years ago to read “unless the prescriber writes DAW,” but the industry publications have not made this change.

Nevertheless, things are changing. There are now some 260,000 NP and PA clinicians in practice, all of whom can prescribe in all 50 states. Twelve thousand or so graduate each year with prescribing privileges in every state. In the vast majority of states, NPs and PAs have their own DEA numbers, and some even own and/or run their own clinics. Some can practice with no physician involvement at all.

Has the industry embraced or really grasped our potential?
Many sales representatives have, but products still launch that would enjoy significantly increased sales if some marketing efforts were dedicated to PAs and NPs. If product managers were to invest even 5% of their budgets to the PA and NP audiences, it would pay huge dividends.

I realize ROI still rules the day. I know that being able to show your investment brought back more than you spent is an important part of business. I realize that because most audits do not report on NP and PA prescribing, the chips are stacked against us and that to some we still have to prove ourselves. Now we finally can. In many states the PAs and NPs have a new NPI number that is required on every prescription they write. The industry can insist that the NPI number of the specific prescriber be used in tracking prescriptions and that the prescriber who signed the prescription be identified. Marketers need this information. Fifty thousand prescribers can make or break a product’s success.

I personally invite you to come to the national PA or NP meetings and sit down with a few NPs or PAs and ask them about your product. What do they use? Why? You will generally find that the answers are at least as illuminating as most you have heard from physicians. Sometimes you get a whole new set of insights to consider. I can personally round up a number of people to speak with you. Please take me up on that. I know you will get more than you give if you take a closer look at us.

I will leave you with one more thought, NPs and PAs are prescribing someone’s product multiple times each day. With a bit of attention and support, it could be your product. All it will take is this small step to start gaining on the competition. There are some 260,000 PA and NP prescribers out there waiting to prescribe your product.

David Mittman, PA, is President-Elect of the American College of Clinicians and co-founder of Clinician1.com, a new social/informational Internet community for PAs and NPs. He can be reached at david@clinician1.com.

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