The Evolution of a Pharm-Free Office Pharmaceutical Industry Influence by tyty722

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									           The Evolution of a
           Pharm-Free Office
       The Story of Madras Medical Group




       Pharmaceutical Industry
             Influence

Drug rep presence increased as town to the south
    grew

Increase in visits and in lunches




                                                   1
    Pharmaceutical Industry
          Influence


Increased concern among some providers

Increased excitement among some providers
    and staff




               Concerns

Bad for patients
Taking up time and reducing productivity
     don’
Just don’t like talking to reps
Drug samples of limited value to patients and
     practice




                                                2
                                        30                                                           27.7
Promotional expenditures ($ billions)
                                                                                              24.1
                                        25
                                                                                         21
                                                                                  17.8
                                        20
                                                                           15.7
                                                                   13.9
                                        15                  12.5
                                                    11
                                               9
                                        10

                                         5

                                         0
                                             1996 1997 1998 1999 2000 2001 2002 2003 2004




                                                        Journal Ads 1.9%
                                                        $499 million

                                        Detailing to
                                        doctors 26.4%
                                        $7.3 billion



                                                                                         Samples 57.2%
                                                                                         $15.9 billion


                                          DTC ads 14.5%
                                          $4.02 billion




                                                                                                            3
A physician survey of the effect of drug
                       physicians’
sample availability on physicians’ behavior
HTN scenario:

    Patient now has health insurance, blood pressure
     controlled on drug sample
    69% said they would write a prescription for the
     sampled medication rather than switch therapy.
    88% of sample users would have written a
     prescription for a drug that differed from their
     preferred choice.



 J Gen Int Med 2000;15:478




           Pharmaceutical lunches
2/7/03         Pharmacia        6/5/03        Aventis
2/26/03        Aventis          6/19/03       Searle
3/4/03         Pfizer           7/8/03        Takeda
3/11/03        Aventis          7/24/03       Pfizer
3/20/03        Parke-Davis      8/20/03       Takeda
4/3/03         AndRx            9/4/03        Pfizer
4/10/03        Ortho-McNeil     10/1/03       Forest
4/22/03        Merck            10/16/03      Pfizer
5/7/03         Norco            10/31/03      GSK
5/8/03         Pfizer           11/6/03       Ross
5/13/03        GSK              11/20/03      Pfizer
6/3/03         Forest




                                                        4
       DRUG REP VISITS - 2005

             MAY                          36 visits
             JUNE                         37 visits
             JULY                         29 visits
             AUGUST                       31 visits
              -------------------------------------
             SEPTEMBER                    18 visits
             OCTOBER                      15 visits
             NOVEMBER                     11 visits




           Sample Cabinet Inventory
Tevetan        AWP    $50        Cymbalta      AWP    $102
Omnicef               $93        Prempro              $37
Cozaar                $50-65     Lipitor              $70-90
Flomax                $58        Tricor               $35-95
Asmanex               $598       Micardis             $50
Ultracet              $30-100    Singulair            $90
Avodart               $83        Zyrtec               $63
Viagra                $9/pill    Skelaxin             $80-240
Xopenex               $120-180   Avandia              $130
Coreg                 $100       Advicor              $160
Imitrex               $17/pill   Diovan               $50
Benicar               $50        Altace               $40
Zelnorm               $170       Fosamax              $70




                                                                5
      Sample Cabinet Inventory
Norvasc    AWP $59          Altoprev     AWP $80
Vytorin                     Actoplus Met
Enablex          $88        Levitra          $9/pill
Starlix          $35        Paxil CR         $88
Actos            $102-164   Niaspan          $50-80
Namenda          $140       Spireva          $120
Boniva           $76        Hyzaar           $48-62
Vesicare         $100
Pravacol         $89-130
Sanctura         $46
Avapro           $45
Zocor            $80-130




                  Obstacles

   Not all docs on board
   Staff enjoy the trinkets and lunches
   Chance for practice to get together and socialize
   Concern for those patients who do rely on
        samples
   Public perception




                                                       6
               Small Steps

Limited lunches to once per month

Some docs demanded peer review info only

Offer to reps to listen to their talk if they
    created a fund for indigent patients




      Overcoming Obstacles

Not all docs on board

   The Truth About the Drug Companies
       by Marcia Angell, MD

   Vioxx and NEJM

   Increased press




                                                7
          Overcoming Obstacles
   Staff enjoy the trinkets, pens, and lunches
   Chance for practice to get together and socialize

   Once per month staff lunch to socialize
   Made list of items needed to replace and bought
      them at local businesses
   Tough luck on the trinkets




   List of items needed to replace
Pens                        Paper clip holders
Tablets                     Calculators
Clocks                      Mugs and cups
Staplers                    BMI calculator
Tape dispensers             Magnets
Post-it notes               Salt and pepper shakers
Scissors                    EKG calipers
White out                   Obstetrical wheels
Pen holders                 Monofilament testers
Letter openers              Q-tip and cotton ball holders




                                                            8
        Overcoming Obstacles


   Public perception

   Newspaper article and conversations with
    patients




        Overcoming Obstacles


Concern for those patients who do rely on samples

Still concerned about few patients and samples




                                                    9
 The Big Day


                 January 1, 2006

  Purged office of pharma logos
       No more drug reps




                  The Big Day
Madras Medical goes
 pharm-free
Bend Bulletin
1/7/06
Madras Medical
 Refuses drug
 company gifts,
 samples
Madras Pioneer
1/18/2006




                                   10
             The Aftermath

Very little negative from patients
P.A. trying to meet reps in other places
Can’
Can’t find pregnancy wheels and monofilaments
      without labels
Staff pretty happy with lunches but miss pens and
      tablets
Thank you note
Sometimes tough to find a pen or tablet
Practice across the street de-facto pharm free
Patients very understanding – poorer better than rich




                   Closing

Traditional family practice in conservative
    community
Not radicals
Mostly positive feedback
More pleasant workday and workplace




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