Study: Doctors Prescribe More Judiciously When Drug Reps Are Kept at Bay

Detailing policies lead to increased use of generics

When academic medical centers (AMCs) put pharmaceutical sales representatives on a shorter leash, their doctors tended to order fewer promoted brand-name drugs and used more generic versions instead, according to a study published in the Journal of the American Medical Association.

The study, conducted by the University of California, Los Angeles, Anderson School of Management, focused on 19 AMCs in five states that restricted visits by drug reps in one or more ways: limiting access, limiting gifts, or punishing those who broke the rules. The researchers compared prescriptions written by 2,126 doctors at those hospitals with those of 24,593 peers with similar characteristics who were not subject to the marketing limits. The investigators examined more than 16 million prescriptions, using data from CVS Caremark, a large pharmacy benefit manager.

Significant prescribing changes were observed in six of eight drugs studied and at nine of the 19 hospitals reviewed. The policies were put in place at different times from 2006 to 2011, but changes in prescribing started immediately and lasted for 12 to 36 months afterward.

Eleven of the 19 AMCs regulated salesperson gifts to physicians, restricted salesperson access to facilities, and incorporated explicit enforcement mechanisms. For eight of these 11 AMCs, there was a significant change in prescribing. In contrast, there was a significant change at only one of eight AMCs that did not enact policies in all three areas.

Exposure to an AMC detailing policy was associated with a 1.67% (P P 

An accompanying editorial suggested that alternative approaches to educating doctors about medications—besides relying on drug-company promotion—need to be tested.

Sources: JAMA; May 2, 2017; and ProPublica; May 2, 2017.