Doctors hear alternatives to drug-firm sales pitches

WASHINGTON -- Marcia Drummond sees doctors for a living. On a typical workday, she may drive to points in the entire Washington region to visit pediatricians, internists, cardiologists and family practitioners. A pharmacist by training, she's now a foot soldier in a mounting clash between the pharmaceutical industry and the benefit plans that pay for their products.

For years, the pharmaceutical industry has been sending salespeople called "detailers" to doctors' offices to promote their latest patented blockbuster drugs.

Drummond is a "counterdetailer" -- a paid consultant for a prescription benefit company whose job is to question those sales pitches, to counsel doctors to look at cheaper and generic drugs whenever appropriate. And the rise of this figure in the health care landscape has opened another front in the battle to control prescription drug costs, which have been rising more than 17 percent yearly since 1997.

The most public front was active last week, with the Senate passing a bill intended to make it easier for cheap generic drugs to come onto the market. The bill, sponsored by Sens. Charles Schumer, D-N.Y., and John McCain, R-Ariz., drew considerable support in Congress and strong opposition from the pharmaceutical industry.

But the less visible fronts are constantly active, especially now that drug costs are straining budgets for governments, corporations and unions. And because the most direct way to manage drug costs -- setting the kind of price ceilings found in most other countries -- is politically unacceptable, those involved have had to be inventive.

The advocacy group AARP, for instance, began a $10 million advertising effort this spring to encourage the use of generics and cheaper drugs, using veterans of antismoking ad campaigns.

'A one-two punch'

Then there are counterdetailers, targeting doctors. The states of West Virginia and Michigan have hired their own counterdetailers to visit doctors and encourage them to prescribe generics whenever possible. Legislators in other states, including Vermont, Massachusetts and Washington, have proposed or passed similar programs. First Health Group Corp., which manages prescription benefit plans in 14 states, reports that the states' interest in counterdetailing is growing fast.

It's no coincidence that all this activity on drug costs has occurred as Congress has tried, albeit unsuccessfully, to fashion a Medicare drug benefit that would give coverage to the elderly.

"There is a widespread feeling that there has to be a one-two punch on prescription drugs, that for them to become more accessible they first have to become less expensive," Schumer said. "If nothing is done on the cost side, then obviously it makes it much harder to act on the accessibility side."

To the large and powerful pharmaceutical industry, selling more brand-name drugs is both good and appropriate for health and business reasons, and it is aggressively fighting efforts to limit drug companies' prices and profits.

Enormous savings

However, persuading doctors to prescribe generics, and patients to use them, can bring enormous savings. As explained by Tom Susman of the West Virginia Public Employees Insurance Agency, 43 percent of prescriptions paid by the plan are now generics. If that number grew to 45 percent, he said, the state would save $1 million. That's why he is beginning the state's counterdetailing program, and why the work of people like Marcia Drummond is drawing increased interest.

Drummond works for the prescription benefit company AdvancePCS.

She has printouts that document each prescription filled under the doctor's name, so she can get specific about whether a physician is prescribing expensive brands or generics and "preferred" drugs on the company's approved list. She can recommend changes, based on her knowledge of drug properties and costs, but cannot go beyond that.

"They don't always change what they're prescribing," she said of the doctors, "but they're usually interested, and they listen."