Though I have no pharmaceutical marketing or sales experience, I have spent enough time as a KOL, industry advisor, and customer to learn a few things about your business. I know the axiom that 80% of scripts are written by 20% of physicians, and I know about decile categorization. I also am aware that sales representatives are measured on how well they reach their top-level targets. Though this model may have been successful over the last few decades, times have changed radically: this model is not likely to be very successful now or in the future.

Given my positive experiences with the pharmaceutical industry, I have always taken the opportunity to speak to every rep who has called on me, even if I never use their product. As a primary care physician, I realize it is impossible to keep up with every medication for every disease state. A pharmaceutical representative might actually tell me something that I don’t know something that could benefit my patient. In addition, even with so many excellent products going generic, I have always seen the role for branded products, especially with programs that reduce the patient’s out-of-pocket expense to a tier 2 co-pay. Yet, even though I am a high-volume, rep-friendly, academic physician, in reality I have been a poor choice for a sales call, since I almost exclusively write generic prescriptions.

MORE TIME, MORE BRANDS

Over the last few months, however, everything seems to have changed. I recently got off the insurance treadmill and started a retainer (also known as a concierge) practice. In this new practice, in addition to enjoying the satisfaction of spending quality time helping my patients, I noticed something else: I was writing prescriptions for significantly more branded products.

Why? Did I have more reps calling on me with more samples? No—in fact, I was seeing fewer reps during this time, as many had not yet figured out where to find me in my new location. I ascribe my writing many more branded products to two factors: patient population and time.

In today’s insurance-based system, the primary care physician is forced to see more patients in less time. With high drug costs, a poor economy, and PBM initiatives, patients expect every drug you prescribe to be a $4 generic. Thus, even armed with knowledge, samples, and coupons, I found it virtually impossible to explain to my patients in a limited amount of time why a branded product was worth paying just a little bit more for. Add to this the threat of a prior authorization or step edit. Thus, when a generic was acceptable, I would usually write for the generic, even if a branded product might be more appropriate. Writing a branded product simply wasn’t worth the hassle.

GREATER COLLABORATION

In my current practice, however, I have all the time in the world to spend with patients. This population values its health enough to pay my retainer fee (and the vast majority of my patients would not be considered wealthy). Now my patients and I have the time to review multiple treatment options, generic and branded, covering their advantages and disadvantages including safety, efficacy, cost, and convenience. Even when presented with the less expensive generic option, more and more of my patients chose the branded option (especially if there is a coupon).

The pharmaceutical industry would be wise to focus less on the high-volume prescriber, whose volume is likely high because he takes every insurance possible and sees far too many patients to even consider writing for a non-generic. Rather, they should focus on the primary care physician who has a cash-only retainer or other lower-volume practice. Patients in these practices have a stake in the game and value their health. Physicians in these practices actually have time to spend with their patients to explain the benefits of certain branded products over generics, and why a patient might be better off taking the slightly higher-cost option.

  • Matthew Mintz, M.D.

    Matthew Mintz, MD, FACP, is Associate Professor of Medicine and Director, Premier Access and Executive Services at The George Washington University School of Medicine in Washington, DC. Visit his blog at www.drmintz.com.

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