Over the course of the past year, we’ve seen renewed interest from federal policymakers in curbing pharmaceutical industry marketing practices that increase drug spending for patients, taxpayers, and the health care system as a whole.
This week, the U.S. Department of Health and Human Services took a big step forward to promote price transparency in marketing by issuing a final rule requiring pharmaceutical companies to share list prices in TV ads for most prescription drugs. Congress is also working diligently to pass the Sunshine for Samples Act of 2019, which would shed more light on how drug companies use free samples to influence treatment decisions. (More on that later.)
At Kaiser Permanente, we have long recognized that pharmaceutical industry marketing practices can pollute the drug information environment and steer patients and prescribers toward drugs that cost patients more without delivering better clinical outcomes.
We are encouraged by recent bipartisan efforts to tackle this problem, and urge policymakers to continue building on this important work. Policymakers should focus their efforts on increasing transparency and curtailing misleading pharmaceutical marketing practices in 3 key areas: (1) direct-to-consumer, or DTC, ads; (2) marketing by pharmaceutical sales representatives; and (3) free samples.
Many industries spend billions to push their product to consumers. Why should pharmaceutical advertising be any different?
Pharmaceutical advertising has been booming in the U.S. for decades. In 2017, the pharmaceutical industry spent over $5.5 billion on DTC advertising, $4.2 billion of which was on television advertising.
It’s no secret that exposing people to ads increases demand for the advertised product. That’s true whether the advertising concerns running shoes or prescription drugs. In fact, one survey found that 1 in 8 adults were prescribed a specific drug after seeing it in an advertisement and asking their doctor about it.
But advertising shoes to influence purchasing decisions carries few risks of long-term consequences and most people have the information they need to make an informed decision about which shoes to purchase.
On the contrary, there are many factors with potentially life-threatening consequences that need to be considered when making prescribing decisions, and at Kaiser Permanente, we believe our doctors are best suited to make those decisions with our patients. We’re not alone in this view; the U.S. is one of only 2 countries where DTC pharmaceutical ads on broadcast television is legal.
It’s also worth noting that the advertised brand-name version of a drug is likely to be more expensive than a generic or biosimilar, which may be just as effective and less costly to the patient. In this way, DTC ads contribute to rising health care costs without yielding even marginal benefits for patients.
Consumer ads are only part of the problem: Drug companies spend even more on marketing to doctors
While we applaud this first step by HHS, there’s more work to be done to curtail the influence of drug companies over doctors’ prescribing decisions. In 2016, the pharmaceutical industry spent $5 billion on sales visits to providers and $13.5 billion on free samples.
Marketing drugs to doctors (a practice known as “detailing”) typically involves sales representatives educating doctors about drug products, providing samples of drugs, and establishing friendly relationships with doctors. While detailing can be useful and educational in some contexts, it is ultimately a marketing tactic that can make it difficult for doctors to make informed, unbiased decisions and can steer prescribers toward higher priced, lower value drugs.
While on the surface free samples may seem like a way to reduce costs, they actually have the opposite long-term impact. Research shows that patients who are given samples ultimately have higher prescription costs than those who do not receive them, because they are then prescribed the sampled drug rather than a less-expensive or higher-value alternative.
In addition to impacting affordability, free samples raise several concerns related to safety and quality of care:
- Samples are generally distributed by unlicensed sales representatives, many of whom lack medical degrees and training.
- Doctors are more likely to use drugs given as samples even if that drug is not otherwise their first choice.
- Free samples are not always stored properly, or they expire, because pharmacists, who are typically responsible for overseeing those issues, are generally bypassed in this process.
Kaiser Permanente is proof that there’s a better way
While these pharmaceutical marketing practices are the norm throughout most of America’s health care system, Kaiser Permanente believes that there is a better way. We significantly restrict marketing by pharmaceutical sales representatives that would deter doctors from prescribing generics or high-value therapeutic alternatives.
For example, sales representatives must register to enter our facilities and may not market drugs that are not part of our pharmaceutical formulary (the preferred list of drugs developed by our physicians and pharmacists for use with our patients) unless specifically asked by a doctor.
These best practices enable Kaiser Permanente to deliver pharmacy benefits in a way that ensures doctors — together with their patients — can make unbiased prescribing decisions that are in the patients’ best interest, and also ensures that patients receive the highest value treatment without incurring unnecessary costs.
The path forward for policymakers
There are several opportunities for policymakers to continue this progress, which I had the opportunity to share at a U.S. House of Representatives Energy and Commerce Committee hearing a few weeks ago.
For example, free samples from drug companies are exempt from the Sunshine for Samples Act’s reporting requirements. Policymakers and the public would benefit from more transparency around samples to help us understand how industry detailing might be inappropriately influencing doctors’ prescribing.
Government should also play a greater role in ensuring doctors can access unbiased information about drugs. Agencies such as the Food and Drug Administration, the National Institutes for Health, the Patient-Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality, and others should provide academic information and unbiased sources of information to counter drug company marketing tactics.
We applaud policymakers for their recent steps to take a closer look at the impact of pharmaceutical marketing practices, and we look forward to continuing to build on this important work.