Generic Detailing

Last Monday, the Wall Street Journal ran a story entitled: "As Drug Bill Soars, Some Doctors Get An 'Unsales' Pitch" and prefaced it with the tagline "Negative Advertising." Here's the first few sentences of the article, which will give you the gist of it:

Like salespeople for pharmaceutical companies, Kristen Nocco shows up in doctors' offices with slick brochures, well-rehearsed talking points and the budget to buy lunch.

But Ms. Nocco's goal is the opposite of the company people: She wants doctors to consider alternatives to expensive brand-name drugs.

Ms. Nocco, who used to be an Eli Lilly & Co. saleswoman, is part of an "unsales" team funded by the state of Pennsylvania. Its message is honed by Harvard University professors who say they're trying to help doctors make decisions grounded in scientific evidence instead of company marketing. Many of the approaches Ms. Nocco advocates -- such as cheap generic drugs and lifestyle changes -- would cost less, too. Some of her talking points take on top-selling drugs such as AstraZeneca PLC's Nexium for heartburn and Pfizer Inc.'s Celebrex for arthritis pain.

The effort comes as states and employers are reeling from ever-higher bills for prescription drugs. Pennsylvania alone spends about $3 billion a year on drugs for state employees, poor people on Medicaid and elderly people eligible for a generous drug-assistance program.

The WSJ calls this an "unsales pitch" but it has also been called "counter detailing," which more accurately describes the goal: to counteract the influence of branded sales pitches by the pharmaceutical industry.

Perhaps a more appropriate label would be "generic detailing" because that's what it really is. You just can't convey a negative message (eg, "don't listen to drug company sales reps"), you must also convey a positive message: switch to the generic brand.

PBMs know the score as was pointed out by Pharma Marketing Online Forum member David Brown: "This is in line with one of our PBM clients. They have a banner in their call center 'brand to generic.'"

Pennsylvania probably scored more points with physicians via the WSJ (and other media) article than by the efforts of its meager "sales force" of which Kristin Nocco is an example. BTW, it appears that PA's tactics may mimic the worst tactics employed by the industry. It's hard to tell from the WSJ black&white cartoon image of Ms. Nocco, but she looks young and attractive -- just the qualities that are valued by the industry (and by male physicians). See "Sexy Reps Sell Rx" for more on that issue. In other words: sexy reps also sell generic Rx!

Will down and out pharma sales reps flock to states like PA for a new career in generic detailing?

"Great news for reps, but I bet the sales meetings won't be as fun. Ya gotta love the resilience of the American economy. As Pharma lays off reps, the government could hire them. Then they'd qualify for the government retirement health benefits instead of social security, taking more money out of that program, and we could have a competition for which reps the doctors criticize the most." -- Sam Nalbone, Pharma Marketing Online Forum Member.

Yeah, that'll happen.

Anyway, here are some other comments on this topic from Forum members:

"On one hand, it's a testimonial to the power of the detailing technique. On the other hand, it's a legitimate tactic for payers who want to control costs. To some extent it's old news as counterdetailng was commonplace among managed care companies in the 90s. It's definitely something that will have to be reckoned with by the industry, as payers fight fire with fire." -- Terry Nugent

I doubt that payers have the heart (or budgetary muscle) to fight fire with "fire." After all, pharma companies have upwards of 100,000 reps out there making, what, 5 calls per day or 100 million calls per year? That's some fire. In six months, PA made 1500 "generic calls" or 3000 per year. If all 50 states did as well, that would only add up to 150,000 calls per year or about 0.15% the amount of calls made by Big Pharma. Talk about your share of voice! PA's voice is a whimper in a shit storm. [However, getting an article in the WSJ, that's big!]

Dr Ulhas Ganu agrees:

"I quote one matter of fact statement about tobacco: The amount of money available for Anti-Tobacco Drive is far less than the one available with the people who promote Tobacco usage. I feel, it more or less applies to the Pharmaceutical Scene vis-a-vis Brand versus Generic." -- Dr Ulhas Ganu

Sam Nalbone sees a silver lining in all this:

"If I go to the doctor for a sleeping disorder, I want a prescription, not a lifestyle lecture. If I don't get a prescription then the service I went there for hasn't been rendered and I won't go back. I'm not there for $100 per hour M.D. life-coach. For doctors that really don't want to see patients, lifestyle lectures in place of prescriptions is are 'just what the doctor ordered!'

"Maybe there is a silver lining - how often has the government tried to use sales and marketing instead of laws and regulations to achieve their agenda? Could this be a creative thought and a tacit nod that pharmaceutical firms aren't so stupid after all?" -- Sam Nalbone

Sam makes a couple of points. First, he criticizes the part of the generic detail that talks about lifestyle therapy in lieu of drugs, generic or otherwise. I can't agree with him there. I could cite personal experience where I lost 25 lbs and for the first time in years and -- despite being on various meds -- I have finally gotten my BP and cholesterol under control! Sam, maybe there are some things about your lifestyle that, if changed, could solve your sleeping problem? Or, you could risk taking Ambien and find yourself "sleep-driving" on the wrong side of the road! That could change your life!

Sam also points out the symbiotic relationship between physicians and the drug industry -- both profit from selling drugs, not lifestyle programs. You can blame patients for this, but DTC advertising is a great influencer of patients as the industry will be the first to admit.

A few other comments from Pharma Marketing Online Forum members and then I'm out of here:

"Somehow I feel, getting relevant information to prove the generic drug is better than or equal to the brand is really difficult task. To prove something scientifically one needs data and for that one have to rely on clinical trials results. Barring few govt. funded clinical trials like CATIE, most other clinical trials have the primary objective of proving the brand to be better than the generic.

"If the 'unsales' team will try to prove that Naproxen or Tylenol is better than Celebrex, the probably PFE will come up with loads of data showing that when one takes Naproxen or Tylenol one needs to take Nexium with it to avoid GI disturbances (cost is more than Celebrex alone). If to counteract the above logic, "unsales team" wants to prove that generic Omeprazole+naproxen will do the same trick, then probably they will lack the data as AZN has large trials for Naproxen+Nexium and not Omeprazole+Naproxen.

"To complete the loop probably the 'unsales' team needs to be armed with exhaustive data to prove their point." -- Sameer

Harry Sweeney, as usual, puts the topic in a whole new context:

"Students of the persuasive arts know that for considered purchases (of which healthcare, medicines, etc presumably are), the clincher for most people -- no matter how good the non-personal communications may be -- is human contact (and persuasion), at least for the first decision and, for many people, for subsequent ones as well. As people become familiar and comfortable with a purchasing process, depersonalized information such as pricing, availability, etc facilitates choices without further human intervention. That's one reason why internet sales have taken off. But, internet healthcare information and services is a whole other topic." -- Harry Sweeney

Thanks Harry, for a great idea for a future topic!

BTW, PA's bizzaro-world "unsales team" can do something that regular pharma reps cannot do: provide doctors with free CME!