The Debate on Influencing Doctors’ Decisions: Are Drug Characteristics the Missing Link?

Decision-making by physicians on patients’ treatment has come under increased public scrutiny. In fact, there is a fair amount of debate on the effects of marketing actions of pharmaceutical firms toward physicians and their impact on physician prescription behavior. While some scholars find a strong and positive influence of marketing actions, some find only moderate effects, and others even find negative effects. Debate is also mounting on the role of other influencers (such as patient requests) in physician decision-making, both on prescriptions and sample-dispensing. The authors argue that one factor that may tip the balance in this debate is the role of drug characteristics, such as a drug’s effectiveness and a drug’s side effects. Using a unique data set, they show that marketing efforts – operationalized as detailing and symposium meetings of firms to physicians – and patient requests do affect physician decision-making differentially across brands. Moreover they find that the responsiveness of physicians’ decision-making to marketing efforts and patient requests depends upon the drug’s effectiveness and side effects. The paper presents clear guidelines for public policy and managerial practice and envisions that the study of the role of drug characteristics – such as effectiveness and side effects – may lead to valuable insights in this surging public debate.public policy;side effects;sampling;Physician decision-making;drug effectiveness;drug prescription;marketing efforts;patient requests;pharmaceuticals;sample-dispensing

Pharmaceutical promotion and GP prescription behaviour

The aim of this paper is to empirically analyse the responses by general practitioners to promotional activities for pharmaceuticals by pharmaceutical companies. Promotion can be beneficial for society as a means of providing information, but it can also be harmful in the sense that it lowers price sensitivity of doctors and it merely is a means of establishing market share, even when cheaper, therapeutically equivalent drugs are available. A model is estimated that includes interactions of promotion expenditures and prices and that explicitly exploits the panel structure of the data, allowing for drug specific effects and dynamic adjustments, or habit persistence. The data used are aggregate monthly GP prescriptions per drug together with monthly outlays on drug promotion for the period 1994-1999 for 11 therapeutic markets, covering more than half of the total prescription drug market in the Netherlands. Identification of price effects is obtained by the introduction of the Pharmaceutical Prices Act, which established that Dutch drugs prices became a weighted average of the prices in surrounding countries after June 1996. We conclude that, on average, GP drug price sensitivity is small, but adversely affected by promotion.

Sales Growth of New Pharmaceuticals Across the Globe: The Role of Regulatory Regimes

Prior marketing literature has overlooked the role of regulatory regimes in explaining international sales growth of new products. This paper addresses this gap in the context of new pharmaceuticals (15 new molecules in 34 countries) and sheds light on the effect regulatory regimes have on new drug sales across the globe. Based on a time-varying coefficient model, we find that differences in regulation substantially contribute to cross-country variation in sales. One of the regulatory constraints investigated, i.e. manufacturer price controls, has a positive effect on drug sales. The other forms of regulation such as restrictions of physician prescription budgets and the prohibition of direct-to-consumer advertising tend to hurt sales. The effect of manufacturer price controls is similar for newly launched and mature drugs. In contrast, regulations on physician prescription budget and direct-to-consumer advertising have a differential effect for newly launched and mature drugs. While the former hurts mature drugs more, the latter has a larger effect on newly launched drugs. In addition to these regulatory effects, we find that national culture, economic wealth, introduction timing, lagged sales and competition, also affect drug sales. Our findings may be used as input by managers for international launch and sales decisions. They may also be used by public policy administrators to compare drug sales in their country to other countries and to assess the role of regulatory regimes therein.economics;regulation;culture;drug;international new product growth;penalized splines;pharmaceutical;timevarying effects

Moderating effects of contextual factors on relationship between pharmaceutical marketing strategies and physician prescription decision: A review

Decision–making by physicians on patients’ treatment has received increased  research attention. Research on the effect of marketing strategies on prescription behaviour has tended to generate controversial results. While some researchers reported a strong influence, some found only moderate effects, while others find no influence at all. The main objective of this paper is to review the influence of the marketing strategies by pharmaceutical firms and contextual factors on physician attitude to drug prescription. The paper presents comprehensive information on pharmaceutical marketing efforts through exhaustive review of relevant literature, and identifies the moderating effects of contextual factors on physician prescribing  decisions. It also presents a crucial conceptual model for explaining the theoretical linkages between marketing strategies of pharmaceutical firms, contextual factors and the decision of the physician regarding drug prescription.Keywords: Drugs, marketing strategy, Physician prescription, Drug characteristics, Physician persistence, Cost/benefi

The Debate on Influencing Doctors’ Decisions: Are Drug Characteristics the Missing Link?

Decision-making by physicians on patients’ treatment has come under increased public scrutiny. In fact, there is a fair amount of debate on the effects of marketing actions of pharmaceutical firms toward physicians and their impact on physician prescription behavior. While some scholars find a strong and positive influence of marketing actions, some find only moderate effects, and others even find negative effects. Debate is also mounting on the role of other influencers (such as patient requests) in physician decision-making, both on prescriptions and sample-dispensing. The authors argue that one factor that may tip the balance in this debate is the role of drug characteristics, such as a drug’s effectiveness and a drug’s side effects. Using a unique data set, they show that marketing efforts – operationalized as detailing and symposium meetings of firms to physicians – and patient requests do affect physician decision-making differentially across brands. Moreover they find that the responsiveness of physicians’ decision-making to marketing efforts and patient requests depends upon the drug’s effectiveness and side effects. The paper presents clear guidelines for public policy and managerial practice and envisions that the study of the role of drug characteristics – such as effectiveness and side effects – may lead to valuable insights in this surging public debate

Sales Growth of New Pharmaceuticals Across the Globe: The Role of Regulatory Regimes

Prior marketing literature has overlooked the role of regulatory regimes in explaining international sales growth of new products. This paper addresses this gap in the context of new pharmaceuticals (15 new molecules in 34 countries) and sheds light on the effect regulatory regimes have on new drug sales across the globe. Based on a time-varying coefficient model, we find that differences in regulation substantially contribute to cross-country variation in sales. One of the regulatory constraints investigated, i.e. manufacturer price controls, has a positive effect on drug sales. The other forms of regulation such as restrictions of physician prescription budgets and the prohibition of direct-to-consumer advertising tend to hurt sales. The effect of manufacturer price controls is similar for newly launched and mature drugs. In contrast, regulations on physician prescription budget and direct-to-consumer advertising have a differential effect for newly launched and mature drugs. While the former hurts mature drugs more, the latter has a larger effect on newly launched drugs. In addition to these regulatory effects,

Behavioral Economics and Health Economics

The health sector is filled with institutions and decision-making circumstances that create friction in markets and cognitive errors by decision makers. This paper examines the potential contributions to health economics of the ideas of behavioral economics. The discussion presented here focuses on the economics of doctor-patient interactions and some aspects of quality of care. It also touches on issues related to insurance and the demand for health care. The paper argues that long standing research impasses may be aided by applying concepts from behavioral economics.

Stigma as a fundamental hindrance to the United States opioid overdose crisis response.

Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis

A web-based survey to assess perceptions of managed care organization representatives regarding the use of co-pay subsidy coupons for prescription drugs

textPharmaceutical manufacturers’ use of prescription brand-name drugs coupons and vouchers to subsidize patients’ cost-sharing obligations such as co-pays has increased. The co-pays are used by managed care organizations (MCOs) to give their plan members an appreciation of drug costs as well as to offer incentives to use available equivalent generic alternatives due to lower co-pays. With higher tiered co-pays for brand-name drugs being offset by coupons, little is known about MCO representatives’ perceptions about use of co-pay subsidy coupons for brand-name prescription drugs. The objective of this study was to assess health plan managers and pharmacy benefit managers (PBMs) perceptions on the use of prescription drug co-pay subsidy coupons. An online survey instrument was used to collect data. A convenience sample of 834 MCO representatives was selected from the Academy of Managed Care Pharmacy (AMCP) membership directory. A total of 122 surveys were returned of which 105 were usable surveys, giving a response rate of 13.7%. A five-point, 11-item Likert scale ranging from 1 through 5, (1 = ‘Strong Disagree’ and 5 = ‘Strongly Agree’) was used to measure respondents’perceptions. Some items referred to coupons used to get co-pay discounts repeatedly over a year (i.e., long-term use coupons) while some items referred to coupons distributed for trial purposes (i.e., short-term use coupons). Of the 105 respondents, 42 (40%) “agreed,” while 58 (55.2%) “strongly agreed” that co-pay subsidy coupons encouraged non-preferred brand-name drugs over preferred brand-name drugs. A total of 78 respondents (74.3%) reported that brand-name drug coupons undermined tiered formulary structure. Sixty respondents (57.1%) “strongly agreed” that short-term use coupons increased plan sponsor’s costs and 72 respondents (68.6%) “agreed” that sponsor cost increased with long-term use coupons. A total of 42 (40%) reported to “strongly agree” that short-term use coupons should be eliminated whereas 49 (46.7%) respondents reported “strongly agreed” that long-term use coupons should be eliminated. In summary, MCO representatives believe that brand-name drug utilization is increasing due to prescription drug incentives such as coupons which undermines their formulary controls and in turn, increases health care costs.Pharmac