Is the benefit to your medical group of maintaining ongoing relationships with pharma reps worth the cost? That's a question confronting thousands of hospitals and medical groups today.
Many factors go into exploring that question. For example, while fewer novel medications were approved by the FDA over the past decade, the coming years will see a number of groundbreaking molecules introduced to the market. The question facing hospital systems that manage medical groups — and physicians within those groups — is how can to best access information regarding new drugs, medication warnings, new research and insights into what is best for patients? Can pharma's field sales reps help efforts to efficiently, fairly and reliably educate and update providers?
As with any complex issue, there are points to be made on both sides. And there are also legitimate issues to debate and consider when striving to answer the pharma rep relationship question.
Declining access
Over the past decade, the number of medical practices that routinely see pharma reps has declined, in some cases markedly. The key reasons given were rising costs (which some attributed to over-prescribing high-cost branded prescription drugs); administration costs related to managing rep-physician interactions; and concerns over undue influence and a lack of transparency. Physicians counter that they are well able to discern between reps that provide valuable information and those that simply bring a meal or a mug in exchange for the prescribing of a drug.
Still, concerns remained. As a result of these concerns (and yes, some legitimate points regarding the need for transparency), 2013 saw the expansion of federal mandates, specifically the Physician Payment Sunshine Act governing a number of areas relating to pharma's interactions with providers.
All told, approximately one in five physician offices have stopped seeing reps all together, while 25 percent of practices now see reps by appointment only and by incorporating sensible visitation frequency rules. Still, others use pharma credentialing firms to help ensure that only those reps with information and products designated as key by medical administrators are seen.
However, some in the industry, and on both sides (physicians and pharma), are starting to ask if the pendulum has swung too far. At the core of the argument is the perspective that through its field sales forces, pharma provides prompt and, importantly, convenient access to information on new drugs. After years of slow innovation, 2012 saw 39 new drug introductions, the most in the past 16 years. Biotech drugs in particular will grow into 2014, with a 22 percent increase in new drug introductions. Drugs for the treatment of cancer, HIV and multiple sclerosis, along with new antibiotics, are leading the pack in high-growth categories. What's more, the emerging world of designer, or genetically engineered drugs, is expected to further push the need for prompt access to reliable information channels for physicians.
Determining value
Answering questions about policies related to pharma reps begins with determining and defining value. Mathematically, Value = Benefit (to the medical practice and its patients, derived from the educational interactions with pharma reps) minus Cost (to the practice associated with coordinating those educational interactions, typically measured in hours of administrative time). Therefore, by this definition, you can increase value by increasing the benefit and/or decreasing the cost.
In terms of benefits, industry often makes the following arguments:
- Pharm reps provide timely access to balanced, FDA-approved research and information. By law, all information presented by pharma must be reviewed and approved by the FDA. Deviations result in fines, meaning that pharma carefully sticks to the FDA-approved script. Insofar as this information is shared at the practice (via rep visits), this "delivery mechanism" is particularly efficient and convenient for providers, and organically complements and reinforces the information they receive from medical journals and conferences. Studies show that physicians who don't see reps are slower to change their prescribing behavior and to adopt the latest clinically proven medications, versus those who do see reps. For example, a 2012 report in the Journal of Clinical Hypertension concluded that physicians who don't see reps were four times slower to react to positive information about new products and studies, as well as to negative information about recalls and adverse effects.
- Pharma can actually help with Sunshine Act compliance. The goal of the Sunshine Act is to provide patients and the public with information about the financial relationships physicians have with pharma and medical device companies. With the Sunshine Act, physician and pharma rep relationships are among the most transparent of any industry. Suffice to say, the pharmaceutical industry has a giant incentive to partner with medical groups to ensure compliance.
- Pharma helps practices manage their sample cabinet. Providing samples to providers is a key service offered by pharma. More than 77 percent of practices allow reps to visit to provide samples. Last year there were 116 million rep visits representing $8.4 billion in free products for patients. Reps help physicians manage the sample process, especially true when those providers and reps utilize technology to coordinate and manage the process.
- Helping patients with information on free and low cost drug programs. Reps also are promoting their Patient Assistance Programs. Robust database technologies, such as RxAssist (founded 15 years ago with funding from the Robert Woods Johnson Foundation), are also helping to provide greater communication, coordination and enrollment in PAPs — something practice staff note is a key benefit and time saver.
On the cost side, both parties (but especially medical practices) can leverage technology to reduce, and in some cases eliminate the costs and burdensome administrative tasks associated with managing rep visitation. Reps from most major pharma companies in the U.S. are adopting technology platforms that make coordinating rep visits more efficient for medical practices. They do this for two simple reasons: 1) it helps their customer (meaning the medical group/practice), and 2) because the efficiencies extend to them, as well.
Medical practices spend an average of 15 hours per month coordinating the educational interactions between reps and physicians. Technology can mitigate that time.
Technology has quietly become such a game-changer for medical practices that 22 percent of practices utilizing this form of technology report they would become "no-see" if it were not for their technology solution.
Consider maintaining relationships with pharma, but with caveats
The ongoing complexity of the healthcare marketplace and the need to find efficient ways to educate providers makes relationships with pharma reps part of a comprehensive approach to physician education and patient care.
New technology-based solutions are enabling provider offices to implement programs that put the medical practice in control of which reps have access to providers, when and with what frequency and information. In other words, not only is the tech creating efficiency, it is also improving the situation by giving the medical practice greater control.
But tech doesn't take the place of personal interactions. Practice managers must also look carefully at those reps that are on time, that bring relevant information and that best engage providers. Make sure companies you choose to see carefully monitor and report visits — and that they provide solutions to help you track reporting of your practice's interactions to ensure Sunshine Act compliance.
While the majority of rep visits for most practices come from pharma, if your medical group is like most, you are called on by reps from all kinds of different companies (pharma, biotech, device, disposable, etc.). Your game-plan related to rep visitation should strive to consider all the reps that you spend time with.
Lastly, look for technology solutions that are easy to learn and that can help you implement, track and report on your interaction with pharma in a way that you can use to ensure you are getting maximum value — while meeting your own internal guidelines and mandates.
Clearly, the debate over pharma rep interactions with providers will continue in the coming years. It is an important conversation. Just as clear is the new commitment from pharma to find ways to adapt to the demands of providers for more value, more transparency and better service. Provided the value equation remains positive for medical practices, with benefit equaling or exceeding cost, then for many practices there will remain a reason for ongoing pharmaceutical rep visits.
Jay Goss is CEO for RxVantage, a technology platform for medical offices searching for a more efficient way of managing the relationships they have with sales reps. Gross' professional entrepreneurial background includes work for Internet, software and mobile companies, as well as building businesses for large/global companies such as Disney and Reed Elsevier.