What Your Drug Rep Knows

Have you started to switch from a brand-name hypertension drug to a generic version? The rep for the brand-name drug can spot that and tout studies knocking the generic drug the next time he delivers pizza.

About 80,000 pharmaceutical representatives - a.k.a. drug reps or detailers - know the individual prescribing habits of roughly 800,000 practicing physicians on a monthly basis.

Reps can customize their sales spiels, because drug companies buy your prescribing data from data-mining companies that bought it from pharmacies. True, the data has been stripped of anything that would identify patients. But your name hasn’t been stripped out.

Plenty of physicians know all this and don’t care. But some who discover that Big Pharma has been acting like Big Brother react with shock, says family physician Gary Sobelson in Concord, N.H., who supported legislation in his state to restrict the use of prescription data for marketing purposes.

“Doctors are outraged on a privacy level,” says Sobelson, a former president of the New Hampshire Medical Society. “It’s like talking to a car salesman who knows what’s in your bank account. Doctors feel the prescription information belongs to them and shouldn’t be sold.”

If you’re outraged, or just annoyed, by Big Pharma’s intelligence operation, there are a few steps you can take to limit its access to your prescribing data. You also can elect the nuclear option: Stop seeing reps.

Look to the Rx law

Don’t look to HIPAA to keep your prescribing habits off the pharmaceutical industry’s radar. The federal privacy law doesn’t apply to health information that has been stripped of identifying patient information, says Deven McGraw, a health privacy expert with the nonprofit Center for Democracy & Technology. The prescriber’s identity doesn’t enter the picture, although during last year’s healthcare reform debate, some Senate Democrats proposed banning the use of prescription data for marketing when it identifies either prescriber or patient.

If you practice in New Hampshire, however, you enjoy this kind of Rx privacy, thanks to a 2006 law. It shields prescriber-specific data, but it doesn’t prevent drug companies from buying data broken down by geographic region or specialty. So drug reps still have something to work with, and they’re still free to knock on anyone’s door.

Vermont has a similar law that bars the sale of prescriber-specific Rx data for marketing purposes unless prescribers sign a consent form. As of December, 14 percent of the state’s licensed MDs had waived their privacy, according to the Vermont Department of Health. Maine passed a law that reverses the process - prescribers must complete a form to withhold their data from marketing-minded third parties.

Variations of these measures have been proposed in other state legislatures, according to the National Legislative Association on Prescription Drug Prices. So enacting a law where you live is one way to limit what Big Pharma and data miners can do.

But can you make the law stick? The New Hampshire legislation weathered an unsuccessful court challenge from IMS Health and Verispan, two data-mining companies that buy prescription information from pharmacies and sell it to drug companies. A federal judge overturned the Maine law in a victory for data miners, although the state is appealing the decision. Data miners have taken their legal battle against the Vermont law to the federal appellate level.

The data mining companies criticize these laws as violating their constitutional right to free speech and potentially jeopardizing patient safety by preventing the use of physician-identified prescription data for clinical activities, including research. They also argue, as they did in one court pleading, that their work helps “ensure that the right doctors receive the right information about the right drugs so that the doctors can make the right choices for their patients.”

Opt out with AMA’s plan

The American Medical Association gives physicians - members and nonmembers alike - a means of keeping their Rx life private, although it’s a partial degree of privacy. Through its Physician Data Restriction Program, you can withhold your prescribing information from drug reps and their immediate supervisors. To sign up, visit the AMA Web site and search for PDRP. As with similar state laws, opting out through this program doesn’t ban detailers from your practice.

The AMA doesn’t buy or sell Rx data, but it does sell its database of physician demographic information to data mining companies. The AMA states that such companies must honor a physician’s desire to curtail the use of prescribing information based on their licensing contracts with the association. As of December, some 25,000 physicians had enrolled in the PDRP, according to the AMA.

However, the PDRP has loopholes. Drug companies still can find out the particular drugs you order; they just aren’t allowed to share that information with a drug rep or his manager - on their honor. And drug reps are permitted to know your percentile ranking in the therapeutic classes of drugs you prescribe, notes general practitioner Adriane Fugh-Berman, who helps operate PharmedOut (www.pharmedout.org), a group seeking to reduce Big Pharma’s influence.

“A rep can see that you’re in the top 10 percent of prescribers for antidepressants, for example, but not whether you prescribe Paxil or Zoloft,” says Fugh-Berman, an associate professor of physiology at Georgetown University School of Medicine.

Close the door to reps

Fugh-Berman says that instead of relying on the PDRP or state laws to shield your Rx data, all you have to do is refuse to see drug reps.

This decision, of course, hinges on what you think of drug reps. Roughly 80 percent of physicians welcome them, says Fugh-Berman. And many physicians say they’re thankful for the product information, samples, and free meals.

However, Fugh-Berman and other physicians contend that drug reps represent a biased, unreliable source of information about medications. Furthermore, the argument goes, drug reps drive up the cost of healthcare since they push new, expensive drugs through their spiels and samples even when less expensive drugs - particularly generics - can get the job done.

From the perspective of Big Pharma critics, the question is whether you want to share prescribing information with a drug rep who will use it to craft a sales pitch. And sales is the name of the game, as evidenced by this e-mail message, obtained by the New York Times, from a drug-company district sales manager to field reps six years ago:

“Our goal is 50 or more scripts per week for each territory. If you are not achieving this goal, ask yourself if those doctors that you have such great relationships with are being fair to you. Hold them accountable for all of the time, samples, lunches, dinners, programs, and past preceptorships that you have provided or paid for and get the business!”

It’s your call whether your prescribing habits are any of their business.

Robert Lowes is an award-winning journalist based in St. Louis who has covered the healthcare industry for 21 years. He can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the March 2010 issue of Physicians Practice.