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E-DRUG: Money magazine on drug promotion (fwd)

  ---------- Forwarded message ----------
  Date: Thu, 15 May 1997 06:39:59 -0400
  From: ra@the.usp.org
  Reply-To: e-drug@usa.healthnet.org
  To: e-drug@usa.healthnet.org
  Subject: E-DRUG: Money magazine on drug promotion
  E-drug: Money magazine on drug promotion
       Dear E-druggers,
       Thought this maybe of interest to fellow E-druggers.
       Syed Rizwanuddin Ahmad
       Wednesday, May 14, 1997
       Drugmakers pressuring medical pros to prescribe their
       Money investigation finds sound medicine may take back
       seat to bottom lines
       by Ira Hellman
       Major drug companies routinely pressure doctors,
       pharmacists and insurers to push, restrict or even switch
       prescriptions to benefit the companies' financial health,
       and in some instances, Money magazine reports in its June
       issue, the practice has even harmed patients.
       A three-month Money investigation reveals that
       drugmakers and bureaucratic middlemen called pharmacy
       benefit managers are increasingly using discounts,
       rebates and other pressures and inducements to wrest
       control of prescriptions from the medical professionals
       on whom patients have relied for generations. The
       business stakes are high, reports Money writer Peter
       Keating: Consumers and their insurers spent $78 billion in
       the U.S. last year to fill 2.5 million separate
       prescriptions. Yet, if anything, the human stakes are
       Money relates chilling stories of patients forced to
       suffer, or to pay stiff out-of-pocket expenses, because
       drugs their doctors had prescribed were not on their
       insurers' "approved" lists. Moreover, it notes that
       switching prescriptions can increase patients' risk of
       getting medications that may not work best for them.
       Indeed, Dr. Philip Alper, a Burlingame, Calif. internist and
       one of the few doctors who would speak with the
       magazine on the record, calls the practice "massive,
       underfunded human experimentation." Among Money's
       * When managed-care plans decide which drugs they will
       pay for, one of the first factors they consider is which
       drugmaker offers the best rebate program. Virtually all
       managed-care plans maintain lists of approved drugs
       called formularies, allowing patients to buy certain drugs
       cheaply at selected pharmacies. Trouble is, these once-
       extensive lists are being whittled down--in one case, to
       only 89 medications--by drugmakers who strike deals
       with pharmacy benefit managers (PBMs). Drug companies
       often offer rebates or discounts to get PBMs and
       managed-care plans to push particular products. In other
       cases, they have simply bought PBMs, which ironically
       were created to help lower prescription costs--and did so
       prior to the '90s. In fact, since 1993, drugmakers have
       acquired the nation's three largest PBMs, at a total cost
       of $12.9 billion. Money notes that most HMOs and PBMs
       insist that they make sure their lists include a broad
       range of medications.
       * Drug companies exert pressure on doctors and
       pharmacists to change your prescriptions. Pharmacists
       and doctors are regularly bombarded will letters, calls
       and faxes--many including offers of cash payments--
       urging them to stop prescribing certain medications in
       favor of others. Some of the approaches are routine
       marketing ploys, Money reports. But others are over the
       top. "I get phone calls asking me to switch my patients'
       prescriptions about 10 or 12 times every day," says Dr.
       Giacomo Buscaino, a Brooklyn cardiologist. "I've been
       asked to switch specific patients to drugs that haven't
       been proved to have the effects they need. I've been asked
       to switch patients to drugs that were more expensive
       than the ones they were on already."
       * Drugs are being switched even when there is no evidence
       that the change is always safe for patients--or cheaper.
       Medical experts, including the American Medical
       Association, are overwhelmingly opposed to restrictive
       drug lists and to marketing programs that reward health
       professionals for substituting one prescription for
       another. Moreover, recent research indicates that reducing
       access to prescription drugs could actually increase
       overall long-term health-care costs. The reason: Patients
       who don't get the prescriptions they need end up using
       more drugs and going to doctors and hospitals more
       Money details ways prescription patients can get what
       they need. Among the tips: Ask your insurer for a copy of
       the procedures you would have to follow to request
       reimbursement for drugs that are not covered. Question
       any changes in your drugs. And support public policies that
       will promote health, not profits, as the primary objective
       of prescription benefit programs.
       The full text of the story is accessible on the magazine's
       World Wide Web site at http://money.com.
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