Salespeople push expensive drugs with samples at clinics; some doctors are banning their visits

Tired of pushy drug company representatives trying to talk them into purchasing and prescribing higher priced medication, doctors at a practice in the 6,000 town of Madras, Ore., decided in 2006 to ban drug reps from their office, and have openly promoted the idea that others should follow suit, Markian Hawryluk reports for The Bulletin in Bend. Bulletin photo by Ryan Brennecke: Dr. Doug Lieuallen with patient Reba Powell)

In the six months before Madras Medical Group enforced the ban, it had 199 visits from drug reps, with 23 bringing lunch for the office staff. An analysis of 46 drug samples left by the reps showed that the average cost of getting those drugs by prescription was $90 per month, when generics were available for 38 of the drugs at an average cost of $22 per month. "Samples are primarily given to promote the use of the more expensive, brand-name drugs, which in the end may be no more effective than lower-cost generics," Hawryluk writes. "But studies show that once a patient is started on a medication with a free sample, he is rarely switched to a lower-cost alternative."

Other businesses in the area have followed suit, with St. Charles Family Care in Bend no longer seeing drug reps, and Bend Memorial Clinic, the region's largest multi-specialty clinic, saying it will cut ties within its primary care offices this year, Hawryluk reports. From April, 2012 to March, 2013 the number of drug reps in the U.S. dropped from 105,000 to 72,000, according to market-research firm Cegedim Strategic Data. "Spending on drug samples fell from $8.4 billion in 2007 to $6.3 billion in 2011. And the number of drug rep visits that included samples dropped 35 percent from 116 million in 2007 to 76 million in 2011. Some of that may be due to the economic downturn, and some to the large number of brand-name drugs whose patent protection has expired in recent years." (Read more)

The situation at Madras Medical was featured in the Journal of the American Board of Family Medicine. The report "suggests that improved health care and significant reductions in drug costs might be attained by breaking up the age-old relationship between physicians and drug company representatives who promote the newest, more costly and often unnecessary prescription drugs," according to a release from Oregon State University. Dr. David Evans, who was a physician at Madras Medical when the ban took effect, said in the report: “This is a culture change, one that’s already happening but still has a ways to go, especially in smaller private practices. The relationship between physicians and drug company representatives goes back generations, and it took a methodical, deliberate campaign to change it." (Read more)