More Physicians Saying 'No Drug Reps Allowed'

September 13, 2016

The once warm relationship of physicians and pharmaceutical reps bearing samples and sandwiches is getting colder, although many prescribers may wish it were otherwise.

The percentage of physicians who do not permit access to medical industry salespeople, who include device-maker reps, has grown to 36.5% in 2016, up from 22.9% in 2010, according to a new survey by the research firm SK&A. And, significantly, among the increasing number of physicians employed by hospitals and health systems, the no-access rate tops 50%.

Physicians who work for Big Box enterprises, of course, no longer make the rules on seeing drug reps, their employers do. And many hospitals and health systems now prevent drug reps from visiting their employed physicians, or else make it harder to do so.

The closed-door policy stems in part from published research showing that drug samples, sales pitches, and free food influence physicians to prescribe medications contrary to the best evidence for clinical effectiveness and cost-effectiveness. According to a study published in JAMA Internal Medicine in June, a single drug-rep meal is all it takes to make a physician more likely to prescribe an expensive brand-name statin instead of a less expensive generic statin.

The Open Payments program created by the Physician Payments Sunshine Act (part of the Affordable Care Act) also has come between drug reps and physicians. The law requires drug and medical-device manufacturers to report to the Centers for Medicare & Medicaid Services (CMS) every "transfer of value" of $10 or more to physicians and teaching hospitals. CMS began posting industry payments to physicians and teaching hospitals on its website in 2014.

The Open Payments program has made health systems and hospitals even warier of drug reps, which may help explain why the no-access rate jumped from 27.8% in December 2013 to 36.5% in June 2016. For example, ThedaCare, a health system in northeast Wisconsin, announced in 2013 that its physician clinics would no longer admit reps from drug and medical device companies in light of the Sunshine Act.

"Patients want and deserve complete confidence that their interests are the only interests when prescribing decisions are made, and by making this change, we can provide that confidence," a ThedaCare executive said in a news release at the time.

Adriane Fugh-Berman, MD, a prominent critic of Big Pharma sales tactics, told Medscape Medical News that it's not exactly clear what percentage of health systems and hospitals ban drug reps from visiting their employed physicians. Dr Fugh-Berman is director of PharmedOut, a project at the Georgetown University Medical Center in Washington, DC, to promote evidence-based prescribing and educate physicians about inappropriate pharmaceutical marketing.

"It would be fair to say that some doctors would see drug reps if their employers allowed them to," said Dr Fugh-Berman, an associate professor in the Departments of Pharmacology and Family Medicine at Georgetown University.

The South Is a Relative Drug-Rep Stronghold

Although drug reps face more closed doors in 2016 than they did 6 years ago, their ability to get inside a physician's office varies considerably by region. The no-access rate is highest in the West and lowest in the South.

Table 1. The West Is Worst for Drug Reps

Region Percentage of Physicians Not Granting Access to Drug Reps
West 42.4%
East 37.5%
North 38.2%
South 30.9%

Source: SK&A.

 

In some states, roughly 6 of 10 physicians turn away drug reps.

Table 2. Drug Rep Access to Physicians by State

Top Three States Percentage of Physicians Not Granting Access to Drug Reps
Vermont 63.7%
Minnesota 59.6%
Maine 56.9%
   
Bottom Three States  
North Dakota 26.6%
New Jersey 26.0%
Mississippi 24.6%

Source: SK&A.

 

The SK&A survey found one trend that seemingly runs counter to the rest of the results. Although the percentage of physicians who won't — or can't — see drug reps has risen, the percentage of those who don't require, or prefer, an appointment with a rep has fallen, from 49.8% in 2010 to 35.2% in 2016.

The findings from SK&A are based on telephone interviews with 297,000 medical practices representing some 740,000 physicians.

Follow Robert Lowes on Twitter @LowesRobert

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