While there has been a lot of focus on high drug unit prices, when the price of a product is high, to control spending you also want to use less of it. Drug companies are master marketers and one technique employed by health institutions has been to restrict sales representative access to physicians who might be prescribing drugs. Research in the Journal of the American Medical Association examines whether these restrictions have an effect on prescribing behavior. (JAMA Article) The test sites were academic medical centers, some of which enacted policies restricting access. The prescribing behavior of 2126 physicians at 19 academic medical centers was compared before and after restrictions went into effect and was compared with the behavior of about 25000 matched control physicians at institutions with no restrictions. 262 drugs were looked at, most were highly detailed but one class was used as a comparison that was not highly detailed, although widely used. It should be noted that the sales rep access restrictions did not completely preclude contacts but limited transfer of things of value and/or limited where contacts could occur and in some cases included penalties. But the salespeople were still likely to be able to communicate with doctors.
There was a greater percentage of specialists in the control group, and, obviously because there were many more physicians in it, the control group wrote more prescriptions. The relative prescribing of the detailed drugs in the pre-intervention period (before the detailing control policies were enacted) was similar in the control and intervention groups, including time trends in the relative share of specific drugs. In a sub-analysis adjusting for brands which had generic competition beginning in the study period, relative prescribing was also similar in the pre-intervention period. Following enactment of the restriction policies, prescribing behavior began to diverge. Implementation of the policies was associated with a 1.67% decline in market share of the detailed drugs. These results were statistically significant for 9 of the 19 centers in the study. Detailed sleep-aid drugs, heartburn medications and ADHD drugs had declines of 5% or more in market share. Generally this meant that prescriptions were shifting from branded drugs to generic ones. The results suggest that the policies had some effect on prescribing of more expensive drugs. A full ban on detailing might have even better results. Doctors can find better ways to get information on drugs.