US Pharma reps - how they are trained, how they target customers, how they affect prescribing

In 2004, spending for prescription drugs in the US was US $188.5 Bn. in 2005 ( 5 times what was spent in 1990) accounting for 10.7% of health-care expenditures. In 2000, pharmaceutical companies spent more than US$15.7 Bn. on promoting prescription drugs

US$ 4.8 Bn. of that went on detailing, the one-on-one promotion of drugs to doctors by pharmaceutical sales representatives / drug reps. The average sales force expenditure for pharmaceutical companies is $875 million annually.

Between 1995 and 2005, the number of drug reps in the US increased from 38,000 to 100,000 - about one for every six physicians. The actual ratio is close to one drug rep per 2.5 targeted doctors

A drug rep can expect to earn on average US$81,700, - base of approx US$60K plus $19,300 in bonuses.

To recruit, hire, train a rep costs about US90K - a pharma company can expect to spend US$150K per rep annually and double that for a speciality rep.

Against this outline of costs Following the Script: How Drug Reps Make Friends and Influence Doctors by Adriane Fugh-Berman and Shahram Ahari is an attempt to explain how drug reps actually work in the US.

The US has a unique, detailed and acurate method of tracking drug sales, by product, and prescriber.

1. Health information organizations, such as IMS Health ( is the biggest and cover 70% of prescriptions made), Dendrite, Verispan, and Wolters Kluwer, purchase prescription records from pharmacies.

Patient names are not included, the precribing physician is identified only by state license number, Drug Enforcement Administration number, or a pharmacy-specific identifier such identities can be linked to physician names through licensing agreements with the American Medical Association (AMA), which maintains the Physician Masterfile, a database containing demographic information on all US. physicians (living or dead, member or non-member, licensed or non-licensed). In 2005, database product sales, including an unknown amount from licensing Masterfile information, provided more than US$44 million to the AMA.

In the UK such sales would not be permitted under the Data Protection Act.

2. Pharamaceutical companies buy this information - Physicians are ranked on a scale from one to ten based on how many prescriptions they write.

Reps use prescribing data to see how many of a physician's patients receive specific drugs, how many prescriptions the physician writes for targeted and competing drugs, and how a physician's prescribing habits change over time.

“A physician's prescribing value is a function of the opportunity to prescribe, plus his or her attitude toward prescribing, along with outside influences. By building these multiple dimensions into physicians' profiles, it is possible to understand the ‘why’ behind the ‘what’ and ‘how’ of their behavior.” Data can be enhanced from other sources for demographics, but also behavioral and psychographic selections that help you to better target your perfect prospects”

Armed with this information the rep's role has changed over the last decade. He / she ruthlessly targets the physician and categorises them ;

“Hidden gems”: “Initially considered ‘low value’ because they are low prescribers, these physicians can change their prescribing habits after targeted, effective marketing.”

“Growers” are Physicians who are early adopters of a brand. Pharmaceutical companies employ retention strategies to continue to reinforce their growth behavior. etc.,

From this develops the procedures to manipulate Physicians - "Friendly " "Aloof" , "Mercenary" explained in this detailed chart here

Sharham Amari who was a drug rep for a major US Pharma company concludes ..

" The concept that reps provide necessary services to physicians and patients is a fiction. Pharmaceutical companies spend billions of dollars annually to ensure that physicians most susceptible to marketing prescribe the most expensive, most promoted drugs to the most people possible. The foundation of this influence is a sales force of 100,000 drug reps that provides rationed doses of samples, gifts, services, and flattery to a subset of physicians. If detailing were an educational service, it would be provided to all physicians, not just those who affect market share.

Physicians are susceptible to corporate influence because they are overworked, overwhelmed with information and paperwork, and feel underappreciated. Cheerful and charming, bearing food and gifts, drug reps provide respite and sympathy; they appreciate how hard doctor's lives are, and seem only to want to ease their burdens .... every word, every courtesy, every gift, and every piece of information provided is carefully crafted, not to assist doctors or patients, but to increase market share for targeted drugs."

A fascinating insight into part of the process of getting the drugs from the lab to you - read it, and also take a look at the Merck Training Guide which was unearthed as part of the Oversight and Government reform committee Hearing on Vioxx under Chairman Henry Waxman , Item 17 "Merck, Basic Training Participant Guide (Jan. 2002)." see excerpt (click to enlarge) at top of article of part of Page 63 detailing information available to the rep....whilst you are at it this Merck document is a fascinating insight into ...well read it and see.

This is particularly interesting in the light of subsequent events related to prescribing Vioxx.