Is your physician a "Free Luncher"?

[rapunzel]

Oh, I can't wait for Skunky to weigh in on this. Particularly the short-acting patent extension and 20% active ingredient stuff. And R&D budgets vs. marketing budgets.

There are drug reps in that office feeding the staff every day, but he takes leftovers for lunch. The problem is that the nurses are used to great lunches, the patients are used to free samples, and everyone tolerates the schedule-derailing time succubus that is the drug rep pitch.

Granted, there is a need for education on new drugs. Unfortunately, a salesman is not an acceptable source of information for physicians. It would be like going to a Honda dealership and asking the sales guy to tell you which car to buy -- a Honda, a Toyota, or a Mini. Now, many drug companies have started to pay prominent doctors in a given area to give talks on their drugs to their peers. Everytime I see Dr. Jarvis' Plavix commercial I want to puke and wonder how the specialty boards could tolerate this unprofessional bit of whoring...and then I remember the rx companies give the boards and the AMA a ton of money, too.

If you don't like free lunchers, you should refuse to be a free sampler. If you want to do something about the spiraling cost of healthcare, find out the cost of a drug in it's long acting form vs. the short acting generic and decide if you'd be willing to pay for the difference if you were using your own money. Try generics first whenever possible. Factor in the costs in your healthcare decisions. If I have a prescription for a drug with no generic equivalent, I always ask the pharmacist what the cost is -- not what my co-pay is -- and then decide if I'd buy it if I had to pay the whole cost. So many people take the attitude that they should get the "best" drug available -- the newest and most expensive -- because they have insurance and don't really have to pay for the whole cost. They forget that the next year's premium is based on what the group spent this year plus 9-12%.

When more patients refuse the free samples, maybe healthcare providers would show a bit more courage and stop seeing the reps.

 

[hi n dry]

For all you PharmRep haters out there, let me give you a little bit of information that could possibly change your mind about trying to take my job.

....
As for these "high priced" medications versus generic. Did you know that the companies that make generic medications only have 1 thing to show the FDA before they are approved? That one thing is that their medication is within 20% high or low of the active content of the "brand name" medication. Essentially, you could get a different medication everytime you walk in the pharmacy. ..

The previous fear mongering "sales pitch" is a gross misrepresentation about generic drugs and only exemplifies why we don't want our doctors lobbied by corporate drug reps.

The below report from webmd may be a little less biased.

http://www.webmd.com/a-to-z-guides/questions-about-generic-drugs-answered

Frequently Asked Questions About Generic Drugs

What are generic drugs?

A generic drug is a copy that is the same as a brand-name drug in dosage, safety, strength, how it is taken, quality, performance and intended use.


Are generic drugs as safe as brand-name drugs?

Yes. FDA requires that all drugs be safe and effective. Since generics use the same active ingredients and are shown to work the same way in the body, they have the same risks and benefits as their brand-name counterparts.


Are generic drugs as strong as brand-name drugs?

Yes. FDA requires generic drugs to have the same quality, strength, purity and stability as brand-name drugs.


Do generic drugs take longer to work in the body?

No. Generic drugs work in the same way and in the same amount of time as brand-name drugs.


Why are generic drugs less expensive?

Generic drugs are less expensive because generic manufacturers don't have the investment costs of the developer of a new drug. New drugs are developed under patent protection. The patent protects the investment?including research, development, marketing, and promotion?by giving the company the sole right to sell the drug while it is in effect. As patents near expiration, manufacturers can apply to the FDA to sell generic versions. Because those manufacturers don't have the same development costs, they can sell their product at substantial discounts. Also, once generic drugs are approved, there is greater competition, which keeps the price down. Today, almost half of all prescriptions are filled with generic drugs.


Are brand-name drugs made in more modern facilities than generic drugs?

No. Both brand-name and generic drug facilities must meet the same standards of good manufacturing practices. FDA won't permit drugs to be made in substandard facilities. FDA conducts about 3,500 inspections a year to ensure standards are met. Generic firms have facilities comparable to those of brand-name firms. In fact, brand-name firms are linked to an estimated 50 percent of generic drug production. They frequently make copies of their own or other brand-name drugs but sell them without the brand name.


If brand-name drugs and generic drugs have the same active ingredients, why do they look different?

In the United States, trademark laws do not allow a generic drug to look exactly like the brand-name drug. However, a generic drug must duplicate the active ingredient. Colors, flavors, and certain other inactive ingredients may be different.


Does every brand-name drug have a generic counterpart?

No. Brand-name drugs are generally given patent protection for 20 years from the date of submission of the patent. This provides protection for the innovator who laid out the initial costs (including research, development, and marketing expenses) to develop the new drug. However, when the patent expires, other drug companies can introduce competitive generic versions, but only after they have been thoroughly tested by the manufacturer and approved by the FDA.


What is the best source of information about generic drugs?

Contact your physician, pharmacist, or insurance company for information on your generic drugs. You can also visit the FDA website at http://www.fda.gov/cder/ogd/index.htm for more information.


What is Generic Initiative for Value and Efficiency (GIVE)?

On October 4, 2007, FDA launched the Generic Initiative for Value and Efficiency, or GIVE. The initiative will use existing resources to help FDA modernize and streamline the generic drug approval process.

 

[lcauley]

Questiona for you Rapunzel.
If in your opinion, no one should use brand name medications, how would you propose that the companies justify all the money they spend for R&D? Do you think that the industry has come out with enough medications and that every company should quit trying to improve or develop new meds?

As far as short acting vs. long acting- Don't you think that if you had to take a med (even generic) 3 times a day...the brand name once daily may be pretty close in cost for an insurance company? (the co-pay may be less on the short acting for consumers, but insurance still absorbs the cost of all 90 pills)

Samples- I have always thought of samples being a help to insurance companies. Just think about how many free samples the average american gets on a yearly basis. If all patients began to refuse samples, the insurance companies again would absorb the millions maybe billions of dollars once paid by the pharma companies. Another thing to think about....How many times have you gotten a sample for 7 days of a medication...you didn't like it (maybe due to side effects) so you called your physician and got them to change your medication. If you didn't use samples for your trial period, you may have very well been written 30 days of the medication by your doctor. Now the insurance company has paid for 30 day of pills and you only took 7 before throwing the rest out and getting another 30 day supply of a different medication. I am sure there are plenty out there who have also been given enough meds to cover their entire treatment with no prescription, the insurance company definately benefited there!!

Although I have to say...my job is not very glamorous at all. I do get treated like the scum of the earth on most days but then there are times that make it all worthwhile. Those days are when you hear a story about how the medication you educate doctors on daily changed a persons life, and for once, you get thanked for the work you do.
I agree there are some bad reps that don't earn credibility because they bribe for prescriptions, but I do know we all aren't like that. I take my job seriously and I do believe that when you talk to the doctors and make sure that everything you say is factual, objective and patient driven, you are doing your job the right way. I have a life just like everybody else, I have feelings and I like all of you take medications and have seen the change it has made in my life.

 

[scooterbug44]

The only "samples" I've ever been offered were for name-brand meds that cost WAY more than the readily available generic. Samples don't help the insurance industry, they hurt it by jacking up overall costs and getting doctors to prescribe more costly drugs.

As far as your example, if there is a concern about a medication working for your ailment or causing a reaction, the doctor can easily write you a prescription for the 7 days instead of 30 and then change the meds as needed.

This thread is a great example of why free-lunch doctors are so desirable and the pharmaceutical lobby needs to go buh-bye!

Can't wait to see Skunky weigh in!

 

[lcauley]

This was taken from: http://www.fda.gov/cder/orange/obannual.pdf

The statistical methodology for analyzing these bioequivalence studies iscalled the two one-sided test procedure. Two situations are tested with this statistical methodology. The first of the two one-sided tests determines whether a generic product (test), when substituted for a brand-name product(reference) is significantly less bioavailable. The second of the two one-sided tests determines whether a brand-name product when substituted for ageneric product is significantly less bioavailable. Based on the opinions ofFDA medical experts, a difference of greater than 20% for each of the abovetests was determined to be significant, and therefore, undesirable for alldrug products. Numerically, this is expressed as a limit of test-productaverage/reference-product average of 80% for the first statistical test and alimit of reference-product average/test-product average of 80% for the secondstatistical test. By convention, all data is expressed as a ratio of theaverage response (AUC and Cmax) for test/reference, so the limit expressed inthe second statistical test is 125% (reciprocal of 80%).

 

[30A Skunkape]

Interesting thread. Here is what is being unwrapped in our lunch room right now:

Two pans of salad with two jugs of dressing
A huge pan of red beans and rice
At least one huge pan of blackened or baked grouper in a dark sauce over rice
A huge pan of what looks like fajita chicken, Intended to go into or onto something
A huge pan or two of shrimp etoufee
Several gallon jugs of iced tea
Dessert yet to be revealed


OK, I will be having a Lean Cuisine, but most will have the Blue Pill Special. We have some docs here that are all over the free chow, others (including myself) avoid it. I personally hate enduring the sales pitches that are all too often bolstered by biased studies. Almost all the drug reps are pleasant people doing what they are told to do in order to make a living, and I understand that. I do not mean to throw them under the bus at all. They are often treated poorly by many docs behind the scenes and I don't see any reason to be unpleasnt to anybody;I simply do my best to avoid anything beyond casual exchanges.

With limited exception I avoid the sample closet. I will happily dole out stuff that I do not envision being refilled. I always attempt to steer people to Wal-Mart for the $4 formulary or have generics dispensed. If there is a difference in efficacy between generics and name brands, I have not noticed it.

I have purged my office of anything with advertising on it, and that is not as easy as it might sound.

Seacrestkristi, have no fear, all in the office eat well daily. I really don't have a beef with the overworked and underpaid taking a break and enjoying a nice lunch. Why some of my peers in the top tax bracket seem so addicted to free lunch is beyond me. And believe me, when I try to explain to people why I abstain, I get looks like I am from another planet. Here is how the conversation typically goes:
"Dr Skunky, we have Ruby Tuesday for lunch today," I am informed.
"Who paid for it?," I ask
"Drug rep," is the answer
"No, who paid for it?," I ask again. This usually elicits a blank stare which is my cue to do my best to explain some of the economics of the "free" lunch.

The above post is dedicated to the memory of Digger the Dermatophyte. You might remember Digger,he was the guy who lived in your toenails and could only be shooed away with Lamisil, and incredibly expensive drug aimed at correcting a cosmetic problem. Well, it was expensive up until within the last few weeks when it went generic. You can now score a month's worth for $4, which probably wouldn't have paid for one pill two months ago. RIP, Digger

 

[hi n dry]

Big brand name pharmaceutical companies not only spend lots of money influencing our doctors, they also are the "Goliaths" in Washington lobbying and political campaign contributions.

"Brand-Name Drug Companies Versus Generics: Lobbying and Campaign Contributions

http://www.citizen.org/congress/reform/drug_industry/contribution/articles.cfm?ID=8045

"There are basically two kinds of companies in the pharmaceutical business: brand-name drug companies and much smaller generic drug makers, who often compete with the brand-name companies for market share and profits.

The two types of drug companies also compete for political influence in Washington, D.C., and this week the U.S. Senate is considering legislation that would provide consumers with more timely access to lower-priced generic drugs legislation strongly opposed by brand-name companies. ...

A look at the brand-name and generic drug companies lobbying expenditures and campaign contributions shows how outgunned the generics drug industry is when it comes to currying favor with the Capitol's lawmakers.

In its attempts to influence Congress, the brand-name industry has spent more than $423 million during the last three election cycles while the generic drug industry has spent about $10 million, or 2 percent of what the brand-name industry spent."

 

[scooterbug44]

$423 million would pay for a lot of R&D!

 

[NoHall]

Pharm Rep, I don't think you're the devil. You just work for him! (Kidding. I'm thrilled you're here defending your position.)

More often than not, I have to pay to have prescriptions filled. Allegra only went generic recently, after I had paid full price for it for years. I have samples of Pulmicort for my asthma, but have paid quite a chunk of change to have that one filled when the sample closet was bare. The medicine I take for narcolepsy is so expensive that I know other narcoleptics who have gone without it because they couldn't afford it.

You mentioned assistance for low income patients--who pays for that? According to my income, I'm eligible for lots of assistance, but as long as I have a roof over my head I'll pay my own way. I don't scrimp and save to pay for feasts and pens, though.

I have no doubt that drug reps can provide valuable information. I've had plenty of medical experience with "Let's see if this one works, then." I don't think that this thread was started to bash those of you who are providing a useful service. It's always about boneheads who abuse the system...

 

[greenroomsurfer]

Hey Pharm Rep, thanks for helping to string out America. The way I see it your just a federally regulated drug dealer.