Why do Canadian doctors continue to prescribe the most costly drugs?
A version of this commentary appeared in the Huffington Post and the Hill Times
It’s worth clearing the air on this question. After much investigation I can say with much confidence that those well-dressed people with their iPads and their expensive briefcases are teachers.
Well, not teachers in the classic sense of someone who fills our children’s heads with wisdom, but teachers nonetheless, who have small classes — with usually our doctors as their pupils.
Selling pharmaceuticals is an extremely competitive business and companies know that they need to put their best face forward. That face is usually a smiling drug representative whose job it is to teach your physician about the newest medicines being produced today.
In Canada the drug industry spends roughly $3 billion per year marketing its products, two-thirds of which goes towards the salaries of the sales reps who visit our physicians regularly, and the drug samples they use to enhance their one-on-one learning sessions.
If you find it a bit troubling that our physicians are getting their lessons about new drugs from salespeople, that’s the system we have. And it’s something in dire need of reform.
Many doctors dismiss the power of the sales reps but something happened recently that made me acutely aware of how forcefully a drug sales team can bend the prescribing pen. The biggest-selling drug in the world, the cholesterol-lowering agent, Lipitor, went over the patent cliff, which is to say, came off patent recently.
Once Pfizer’s patent on Lipitor expired, generic manufacturers started making and selling the same chemical under the generic name of atorvastatin, at a discount that was up to 75% off the regular price.
If you’re like me with clear traces of Scottish frugality pumping in your veins you’d think: “What a bargain! I’m gonna get some of that generic stuff and save big time.” After all, even if the generic pills are a different colour or shape it’s still the same active ingredient.
But here’s the big question: after much-loved Lipitor sailed over the “patent cliff” did Canada’s doctors, who had been responsible for writing $1.2 billion worth of Lipitor scripts every year, switch everyone to generic atorvastatin?
Nope, that’s not what happened. In the US, when a big name drug goes generic the generic sales take off. In this case, more than 70% of US patients were switched to the generic atrovastatin. Why? US drug plans enforce generic prescribing, so many of them will make the switch to the lower-cost generic drugs.
Canada’s doctors, on the other hand, aren’t significantly influenced by drug plans. In Canada, more than half the former Lipitor patients have been switched to the newest still-patented anti-cholesterol drug, Crestor, which is not proven to be any more effective than generic atorvastatin. And it’s certainly more expensive than the lower priced generic.
The influence of drug reps in keeping patented brands front and centre in our doctors’ minds cannot be underestimated. Even as provincial governments have rules for enforcing generic substitution, many people are covered by their employer-sponsored private insurance plans, which has no such rules.
That’s a pity because in the current economy consumers are being squeezed at every turn, as are governments and employers who want affordable drug care and sustainable drug plans.
We need our policy makers, and the officials who administer both public and private drug plans, to enforce simple cost-saving drug policies. They need to be in the game around educating patients — and doctors — about value-for-money and generic equivalence.
Too long they have left the education of our doctors to the pharmaceutical industry. And that’s a lesson that’s proving to be increasingly expensive for all of us.
Alan Cassels is a drug policy researcher at the University of Victoria and an expert advisor with EvidenceNetwork.ca, a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada.