CBO Report on Promotional Spending for Prescription Drugs

The Congressional Budget Office (CBO) came out with a report on Promotional Spending for Prescription Drugs this week. The report noted that “Pharmaceutical companies’ efforts to promote prescription drugs have attracted the attention of policymakers because such activities may affect the rate at which different drugs are prescribed and consumed, the total amount spent on health care, and, ultimately, health outcomes.”

 

The report focuses on direct-to-consumer (DTC) advertising, which the Food and Drug Administration (FDA) has monitored since the late 90s, as well as other forms of advertising such as sponsorship of meetings, print advertising, and detailing.

 

The report claims that “advertisements for prescription drugs that are aimed at consumers may prompt individuals to seek medical treatment they might otherwise have delayed.” Such an assertion begs the question of what costs more: letting an individual wait to receive the care they need, or seeking out help as soon as information is displayed to that person in advertising, regardless of what format.

 

CBO also notes that DTC advertising may “lead doctors to prescribe brand-name medications that are more expensive than alternatives.” Such a suggestion forgets that some doctors feel comfortable prescribing brand-name drugs because these are the ones typically approved years before a generic rip-off is made. Physicians loyalty to prescribing such brands usually pre-dates any DTC advertising, and doctors are likely more knowledgeable about the side effects and research associated with such drugs from their experience. These reasons make them more likely to prescribe such drugs, not DTC advertising.

 

Ironically, the report acknowledges that “manufacturers of many prescription drugs have increased their purchases of air time on television and of advertising space in newspapers and magazines in an effort to make consumers aware of their products and to encourage them to visit their doctors to request a prescription.” How many commercials do you see for soda, cookies, unhealthy restaurants, and cars? None of the advertising from these products actually helps people. In fact, soda, cookies and eating out actually hurts people and makes them less healthy. So what is all the fuss about for advertising about products that make people healthy?

 

Even as the report itself states, “drug companies use advertising and promotions in much the same way that producers of other goods do: to inform consumers about an advertised product’s existence and uses.”

 

The report also talks about the practice of detailing, when companies send sales representatives to meet with physicians, nurse practitioners, and physicians’ assistants in a practice called detailing. Detailing is extremely important because as the report states, “the representatives discuss drugs manufactured by their company that are relevant to the physician’s specialties, and they may provide product samples and reprints of academic literature that discuss their company’s products.”

 

How else does Congress expect physicians and medical providers learn about such information? Do we really expect surgeons to cancel a procedure to go travel hundreds of miles away to learn about new procedure or medicine? Are we to hope that primary care physicians can cancel thirty-two, fifteen minute appointments for a day to go learn about drugs that help lower patient’s cholesterol?

 

The reality of DTC advertising is clear and simple: “in the second half of the 1990s, the FDA approved an unusually large number of drugs, some of which were the first on the market to treat certain conditions and a number of which treat widespread conditions.” Today, many of those drugs face competition from generic versions, and fewer drugs are being approved because of changes in regulations, which slow the process.

 

Promoting drugs using DTC advertising is critical because it allows “newer to the market drugs” to be promoted to the public. Without such efforts, many patients would never learn of the potential treatments available to them until their yearly check up, when some conditions may be worse, and more evasive procedures are needed. It should come as no surprise to physicians or patients that “treatments for common conditions that affect a large portion of the population—such as high cholesterol, insomnia, or reduced bone density—are a primary focus of direct-to-consumer advertising.” With such a largely affected population, these diseases certainly deserve more air time that cheeseburgers and pizza.

 

Moreover, the idea that “drug companies want to ensure that doctors know about their product and any advantages it has over its competitors,” is essential to keeping physicians fully educated to inform their patients about the risks and benefits of the all the options they have.

 

The importance of DTC advertising is also important “if that large potential market includes many individuals whose condition is undiagnosed or untreated.” In other words, DTC advertising may reduce future costs of chronic diseases by informing patients of new drugs that may help their conditions before they get worse (e.g. high cholesterol).

 

Ultimately, while the report tries to highlight the money spent on DTC advertising as a concern, it merely shows that “the more extensive use of detailing and other promotions to physicians is not surprising because physicians must be prepared to treat patients with both long- and short-term illnesses and both rare and common complaints.” In fact, the report even acknowledges that “some research suggests that DTC advertising encourages individuals to visit their doctors and increases sales for the advertised drug’s class—but not necessarily for the advertised drug itself.” Such research is critical in noting how patients are becoming more concerned about their health from the advertising they see about treatments for conditions.

 

So, while there “is no consensus among experts about the effects of DTC advertising on the sales or prices of prescription drugs,” the most important assertion from this report learned is that “promotional efforts are aimed at physicians to keep physicians abreast of the latest drug therapies and improve their ability to treat patients.”