How Do Drug Companies Know What Your Doctor Is Prescribing?

The AMA sells information about what your doctor is prescribing says an op-ed in the San Francisco Chronicle.

The information is sold without the doctor’s consent (some doctors don’t even know the program exists) and drug companies pay well for it:

One of the less obvious but more intrusive marketing tools is the drug rep’s hand-held computer, which contains a detailed profile of your doctor’s prescribing history. Armed with the knowledge of each doctor’s individual prescribing habits, pharmaceutical sales representatives tailor their pitches to each physician. This strategy has resulted in new, costlier drugs replacing established medications that have proven histories of safety and effectiveness. Industry profits swell, as do the nation’s health care costs.

Few people recognize the role the AMA plays in making physician information available to companies that use it for pharmaceutical marketing purposes. The AMA sells information from its physician “Masterfile” to health information organizations that pair the identifying information with prescribing records from pharmacies and sell the whole package to pharmaceutical companies, a practice commonly called “prescription data-mining.”

The AMA profits handsomely from this agreement. In 2005, the AMA made more than $44 million from the sale of database products, approximately 16 percent of its budget.

Doctors can, however, say no to sales pitches from drug reps, but many of them don’t because they enjoy the free pens, free lunches, free coffee mugs, etc, that arrive along with the drug rep’s visit. Fewer still even realize their information is up for sale by the AMA, which represents only 30% of doctors, yet sells information on all of them.

Prescription mining raises millions for doctors’ group [SFGate via US PIRG]

(Photo:emilybean)

Comments

Edit Your Comment

  1. ger-hardt says:

    My wife is just graduated medical school a little over a year ago, and she used to tell me all kinds of stories where drug reps would come in w/ a laptop and show the doctor what they had prescribed over the course of the previous month, and then question if they prescribed another medication over their own. At the same time they would be treating the entire office to lunch catered by Outback or Applebee’s.

  2. acambras says:

    Ugh. Every time I’m in the doctor’s office waiting room, there’s some sales rep breezing in.

  3. Hambriq says:

    Having been along with some pharmaceutical sales reps on their sales calls, I can tell you that the whole process is a lot less insidious than this article would indicate. Yes, the drug companies know what the doctors are prescribing, and yes, they pay for that information, so technically, it’s “for sale”. But the clinics that the doctors work for consent to this sale of information. It’s not like it’s any big secret. I’m not a doctor, so I can’t say this with 100% confidence, but I’m pretty sure that if you look at the paperwork you sign when you work at places like these, it includes a stipulation about your prescribing information being logged, etc. etc.

    Also, the phrasing of one specific passage stinks of your standard anti-big-pharma stance, “This strategy has resulted in new, costlier drugs replacing established medications that have proven histories of safety and effectiveness”. I’m not saying that expensive drugs are the answer in every case. In fact, the industry could stand to save a lot of money if doctors and patients were more cost-conscious when it comes to prescribing. But here’s the thing: all those drugs with histories of safety and effectiveness were, at one point, new, costly drugs. We should be very careful before we start demonizing Big Pharma. There’s a lot wrong with the way Big Pharma works, but developing and pushing new drugs isn’t one of them.

  4. mbbmd says:

    Hambriq, as a physician, I can tell you that I have never given my consent to anyone to make my prescribing data available to anyone, nor have I ever been asked. Yet the drug cos. have my data too. Just as with your personal financial data, prescribing data is used without consent of the prescriber.
    Just as worrisome, pharmacies sell data to drug companies as well. Unfortunately, not all major chains take part (Wal-Mart, in a surprising show of good corporate citizenship) does not. Thus the data is not accurate without the numbers from the biggest retail pharmacy chain in the US.
    Many docs are not aware of this data free-for-all, and I have been told by many drug reps that they could be fired for showing me the data.

  5. caederus says:

    My wife is an Nurse Practicioner. Yeah the lunches are good, but the 2 big things she gets from the drug reps are the education dinners where she gets continuing education credits (and a meal at a high end resturant), and most important for her, she gets drug samples for her patients.

    Amoung other reasons, the samples are given when a patient is starting a new med and there is a question of tolerating the side efects. Give them the sample and the full perscription. If they are ok on the sample, then fill the full perscription. They can also be given as a starter dose when a pharmacy may not have the medication ready till the next day.

    Having said that the number of lunches and dinners with sales pitches is huge. Even from the companies that she dosen’t use as much.

  6. Sidecutter says:

    Thank god my diabetic endocrinologist has morals. He actually gives me a fair and balanced opinion of the newer drugs I ask about as they come out, including telling me what makes him uncomfortable about them, if anything, and what he needs to see from real-world use, trials, and research before he would consider prescribing them to me.

    When BD announced they were leaving the Glucose testing market, and I asked about it, he didn’t just tell me what he thought were good replacements. He outright gave me two brand new meters, from competing companies, and strip samples, so I could make up my own mind! Now that’s good medical practice.

  7. qwertybot says:

    The dilemma for some physicians (I’ve been shadowing them as preparation for medical school) is that the same drug reps sometimes give the physicians free trial samples, which the physicians give to their patients who can’t afford to pay for medication.

  8. DjDynasty says:

    The reason you got gluecose meters for free, is because those, like the free sample pills, are given to your doctor, by the drug companies, to encourage them to write perscriptions of that product versus another one.

    Personally I like Protonix if it would just quit making me throw up!

  9. galatae says:

    When my husband was in medical school, one of the professors made a point in a board review course of saying that you don’t prescribe medications based on the pens you get, you prescribe based on patient history. 4 years of undergrad, 4 years of medical school and 3+ years of residency, you’d think they MIGHT be able to make intelligent decisions about your care. Sure they take a free lunch, and you do get some trinkets, but ultimately he decides what to prescribe you based on need.

    He also spends about 30 minutes a day throwing up the uninvited pamphlets and pens that drug reps leave around the office for patients to ask questions about. Nothing says ambiguous marketing like a little old lady asking for Viagra.

  10. galatae says:

    BTW, many patients (who don’t qualify for medicaid) could not afford drugs without the samples reps leave, even with the $4 walmart generics. Just a symptom of a larger problem.

  11. rhombopteryx says:

    @Hambriq: (& MBBMD)

    One way this information is collected even without a prescribing Drs. knowledge or consent is through the patient – or more specifically through the patient’s pharmacy. Every CVS, walgreens, RiteAid or Cosco gets to see the prescription when the patient brings it in. They can and do record who prescribed what. The AMA’s biggest database competitors are companies that agregate the info from the pharmacies. The AMA and these companies are literally competing to see who can be cheaper in selling out patient privacy.

  12. imwithfrank says:

    Umm… this isn’t exactly news. The retail pharmacy chains and the insurance companies have been aggregating and selling prescriber information for more than twenty years!!

    The way this usually works: your local pharmacy fills your prescription. The same computer system which handles all the insurance paperwork, prints the label, prints the drug information sheet, etc. also creates a record of prescriber data; typically this identifies the physician, medication, dosage, days of supply, date. No patient-specific information is picked up. The data eventually ends up being delivered to one of the various companies which do this data mining, and is then massaged and sold to the pharmaceutical companies. Part of the massaging is to try to remove the duplicated data mined from many insurance companies or benefit managers.

    Walmart doesn’t contribute data as they do not allow any “proprietary” data past their doors.

    Look at who funds Continuing Medical Education (required in all states to renew licenses) if you’d really like to understand how physicians are influenced…

  13. Berz says:

    @DJDYNASTY
    Taking protonix for GERD or something hartburn related? Sounds like the exact same thing i went through last year. Wake up and Vomit (no beer wasnt involved) and sore throats.

    It helped but I still got sick. Switched to aciphex (spelling?) and that is what actually did the trick for me. Thought I’d share that bit of info.

    /first post evar!

  14. Hambriq says:

    “When my husband was in medical school, one of the professors made a point in a board review course of saying that you don’t prescribe medications based on the pens you get, you prescribe based on patient history. 4 years of undergrad, 4 years of medical school and 3+ years of residency, you’d think they MIGHT be able to make intelligent decisions about your care. Sure they take a free lunch, and you do get some trinkets, but ultimately he decides what to prescribe you based on need.”

    If this really were the case, doctors wouldn’t prescribe bullshit like Solodyn, Adoxa, Pseudovent, etc. etc. etc. For those not in the pharmacy business, all of those drugs cost around 400$ for a month’s supply, despite the fact that their ingredients are common, generically available drugs.

    Don’t get me wrong. I don’t think the problem is the doctors, not directly at least. Nor do I think the bigger problem is Big Pharma. It’s that the only people who really have a keen sense of how much drugs cost are the pharmacies and the drug companies. Doctors and patients are left out of the loop, which creates a massive disconnect, because frankly, we in the retail pharmacy business are just glorified middle men.

  15. Hambriq says:

    @MBBMD:

    Do you work for a clinic, hospital, private practice, etc. etc.? I’m guessing somewhere in the mountain of paperwork, there’s something with your signature on it that has a disclaimer on it that effectively gives your consent. Probably not knowingly, but I’m guessing it’s still there. Of course, I could be wrong. Who knows.

  16. galatae says:

    @Hambriq

    Some do, some don’t. Boils down to knowing what kind of doctor you have. There’s a reason it’s called “practicing” medicine. If it were an exact science, nobody would need a doctor.

  17. aarrgghh says:

    As a former pharam rep I can speak with signifigant professional experience. I live and work in a rural area. Diabetes and hypertension is epidemic here. I promoted a ssri and ARB for hypertension. I took it as my personal responsibility to give out all my samples and I always asked for more. Knowing that many people could not afford the meds and how many people were not being treated. Many Doctors did not want them so much(more stuff to keep up with). Many did. All doctors are not the same. My advice to those that blame the drug companies is to remember they do not write the scripts.
    An interesting fact….Walmart does NOT participate in the sell data. Thats right folks….I hated it too because my rural folks filled a ton of meds there and I never truly knew the real numbers until the end of the quarter when the distribution wholesalers released their sales data. That is how I got bonus. If I increased marketshare…bonus. Its the same widget as everything else.
    There were many times I felt like glorified caterer. Docs have to see so many patients per day to break even. If you interupt them during the day you take away from patients. Lunch’s and dinners is often the only way.

  18. themanishere says:

    @mbbmd: Holy smokes! I guess you don’t know Wal-mart or read business news….the only reason Wal-mart won’t sell the data is because Wal-mart was asking too much and the drug companies refused to pay. All doctor data is known at the company level–the reps are not always given the info as doctors can opt out. But the drug company needs to know who prescribed it in case of a re-call and/or other FDA related reasons (abuse, etc).