Detailing and Sampling Declines and DTC
“DTC is an easy to execute alternative option to offer information.”
The trend is clear. Drug companies have dramatically cut detailing and sampling in the past 5 years. According to ZS Associates, reps totaled 102,000 in 2007 and are projected to be at 75,000 in 2012. TNS Healthcare says for every 100 rep visits only 20 involve actually seeing a doctor. Sampling is down from 2007 as well. Drug companies spent $8.4 billion on samples 2007 and down to $6.3 in 2011 according to Cegedim.
Drug companies are also seeing more resistance to detailing as the number of physicians who refuse to see reps increases. This is related to time crunch as well as policy to avoid undue influence. The greatest resistance to seeing reps comes from larger practices and hospitals. About 14% of small practices refuse to see reps but that number in 10 or more group practices jumps to 44% according to SK&A Information Services.
The negative trend in the medical promotion area makes DTC an important reach alternative. Doctors are consumers too so any DTC reaches doctors. Consumer requests on advertised drugs give physicians the motivation to learn about new drugs, even if they refuse to see detail reps. While DTC will never replace detailing, at least it is an information path that doctors cannot stop. DTC will remain particularly important for lifestyle and weight loss drugs. These categories may be seen by physicians as relatively less important than disease treating drugs. To consumers however, erectile dysfunction and weight loss may be equally important to them as reducing blood pressure or blood sugar.
In a health care system that will be increasingly focused on cost control, drug companies will need to be increasingly concerned about provider and payer actions to influence patients away from branded alternatives. In many cases, generics will do the job effectively but in others the branded drug has significant advantages. The patients need a way to hear about these advantages and at least have providers understand those benefits.
The bottom line is drug companies have a right to commercial speech to sell their products. Without these outlets to promote new products, there will be less incentive to research and develop new products. Advertising may have some negatives in convincing people to buy what they do not really need. It also has the positive effect to make products better by creating comparative claims.
DTC is not perfect, and is by definition biased towards having the drug positively portrayed overall. There are plenty of critics who can also provide the public information on why a drug should not be used. Consumers have the right to hear about those choices and physicians have the obligation to prescribe what they think does the best job. Cost will be an increasing factor in their prescribing behavior. As detailing and sampling decline, DTC is an easy to execute alternative option to offer information to consumers and health care providers. That information system in a free market can be messy but would we have government prevent a free flow of information? FDA regulates it now and requires it to be factually accurate per the approved label. DTC is a valuable tool and will remain so as drug companies scale back detailing and sampling.
Bob Ehrlich, Chairman DTC Perspectives, Inc.