System counters drug companies’ sales tactics
Computer program suggests alternatives>
Pharmaceutical companies often bombard ED physicians with expensive marketing campaigns to get them to use new drugs, but the drugs they promote aren’t always appropriate choices. To expand the amount of drug information available to physicians, a team of physicians in Indiana has developed a special computerized system.
"The drug industry has detail people’ who bring clinicians pens and donuts and encourage them to use certain drugs," explains J. Marc Overhage, MD, PhD, assistant professor of medicine at the Regenstrief Institute for Health Care and Indiana University School of Medicine, both in Indianapolis.
The computerized system he developed along with other physicians provides "counter-detailing," he says. "The physician reads information on screen to counter the drug company’s information, saying Don’t use this drug except under this specific circumstance.’"
The idea is to get physicians to consider using other drugs by communicating a brief message at the time they are writing the prescription. "It’s like a billboard the physicians are driving by, with a sentence to catch their attention," Overhage says.
At times, the information specifically instructs the physician not to use a drug. "You may need to be more aggressive at times and put something in front of clinician that says, Don’t use this drug in this patient,’ if [the patient is] too young or [has] a contraindication. The system suggests some alternatives," he says.
Alternative drugs are suggested that are more appropriate and less expensive. "The system gives specific options to avoid use of expensive drugs when possible," he says. "For example, quinolones are a class of antibiotics which are very popular and very expensive. But there are often good alternatives, particularly with treatment of simple infections."
Specific costs of drugs are listed. "This is very eye-opening to physicians. We may have no idea that an antibiotic costs $2.50 a pill because we don’t buy them," says Overhage.
Drugs listed by cost
The system notes whether a particular drug is on the health plan’s formulary and lists the drugs that are approved in increasing order of cost. "You may see patients in 15 different health plans, and one will have an H2 blocker as their preferred drug, and the other plan won’t even have it on their formulary," he says.
If you give a prescription for a drug and it’s not on the health plan’s formulary, either the pharmacist calls to ask you to change the drug, or the patient winds up paying for it out of pocket. "And in fact, either of the H2 blockers they would get are probably equally effective," notes Overhage.
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