COVER STORY

WHAT R.Ph.s THINK OF DRUGMAKERS

An exclusive, nationwide survey gives a candid view of pharmacists' attitudes toward drug companies

Pharmacists and pharmaceutical manufacturers have had a long-standing professional relationship. But how do pharmacists really feel about the companies that make the medications they sell?

To find out what pharmacists truly think about drug manufacturers, Drug Topics sent a questionnaire to 700 pharmacists from every practice setting and every area of the country. A total of 235 pharmacists responded, representing a 34% response rate. Respondents told us—often bluntly—where they think manufacturers fall short, where they excel, and how they could improve their relationship with pharmacists.

Among other things, we asked pharmacists how they rate the support they get from manufacturers; how often they buy direct; what policies they have in place regarding rep visits; what they would like to see manufacturers change; and their opinions on drug prices, ordering requirements, and pricing structures. The responses we received show that manufacturers sometimes please, but also sometimes anger, their best customers.

Reluctant to buy direct

Pharmacists do little direct buy-ing and have mixed feelings about the practice. Overall, most respondents buy from wholesalers, which accounts for an average of 67% of all purchases (see Table 1). Manufacturers and buying groups account for far less of pharmacies' drug purchases, at only 6% and 8%, respectively. An average of 14% of drug purchases are obtained from other sources, mostly company warehouses.

Table 1
From whom do pharmacies buy drugs*

Independents and those practicing in rural settings are much more likely than others to buy from wholesalers and less likely to buy from manufacturers. Institutional pharmacies and stores in the Midwest tend to buy more from buying groups, compared with retail pharmacies and those in other areas of the country.

Most respondents (88%) said their buying pattern has not changed in the past two years. Pharmacists, it seems, buy from manufacturers when they must. Several respondents, for instance, indicated that drug shortages force them to buy from manufacturers. "Some items we must get directly from the drug company because of lack of allocation or drugs. It's very frustrating," said a Daleville, Va., pharmacist.

Pharmacists showed in other ways that they are less than thrilled about buying direct. Only 14% said they would like to see more manufacturers sell direct to pharmacies. Those in the West are least interested in buying direct, with only 5% saying they would like to see more of the practice. The South is most receptive to the idea, at 16%, followed by the Midwest (14%), then the East (13%). Those who would like to buy direct more often generally cited lower costs and better terms as possible benefits.

Perhaps one reason pharmacists buy little from manufacturers is the minimum shipping orders that they set. In fact, 55% feel that manufacturers set minimum shipping order limits that are too high. A pharmacist from Cincinnati, for instance, observed that the requirements often stop her from making purchases.

Interestingly, male pharmacists are less critical of the limits—36% of them say the policies are acceptable, compared with 17% of female pharmacists. Those in the South are least happy about the requirements, with only 18% saying they are acceptable, compared with 37% in the West, 29% in the East, and 27% in the Midwest. "Such policies close out smaller retailers," noted a pharmacist from Staten Island, N.Y. Another respondent observed that they are an "annoyance."

When asked what minimum order generally kills the deal for them, the average amount was $13,586. More than a third (34%), however, said an order requirement of $10,000 would be too rich for their blood.

Rating drug prices

Perhaps the least favorable feel- ings about manufacturers relate to drug prices. When asked what they thought of the way manufacturers set their prices (see Table 2), most pharmacists classified them as being too high. Prices for new product launches and single-source drugs rankled the most. Fully 89% said prices for new product launches were excessive, and no pharmacists thought prices for new products were too low.

Table 2
A dim view of prices

A close second are single-source drug prices, which 84% said are too high. Almost two-thirds believe price changes for existing drugs are too hefty, and nearly half feel multi-source drug prices are high. These ratings were remarkably consistent across practice setting, gender, years in practice, and geographic area.

Opinions are far less unanimous when it comes to the kind of pricing structure pharmacists prefer. Overall, most would like to see uniform pricing for all practice settings (see Table 3). Independents and chains were more likely to prefer this structure, at 79% and 71%, respectively; institutional pharmacists were less likely to do so, at 46%.

Table 3
Preferred pricing structures

Other pricing structures were also rated. Volume discounts, for example, were most welcomed by institutional pharmacists and chains and those in the East; they were least preferred by independents and those in the Midwest. Special pricing for new products appeals most to chains and least to independents. No independents and only 3% of chains wanted to see different prices for different classes, compared with 31% of institutional pharmacists.

When asked whether discriminatory pricing has decreased in the wake of class action lawsuits against manufacturers, only 13% said it has. A majority of respondents (72%) said it has remained the same, and 15% said it has even increased. Far more pharmacists in the West said discriminatory pricing has increased, and more pharmacists in the Midwest believe it has decreased.

Grading the reps

Most interactions with manufacturers take place through reps, and we wanted to know how often pharmacists see them and how helpful—or unhelpful—pharmacists find them. Fully 85% of respondents were detailed by manufacturer reps this year. More rural pharmacists (94%) tend to receive visits, compared with suburban (84%) and urban (82%) pharmacists. For all respondents who are called on, the average number of visits is two a week. This amount varies very little among all types of communities, practice settings, and geographical areas.

Not everyone said they wish to be visited. Of those 15% of pharmacists who were not called on by a rep in the past year, nearly two-thirds (61%) would like to keep it that way. More female pharmacists (46%) would like to be called on than males (35%), however. Also, independent pharmacists are more open to visits than institutional pharmacists, with two-thirds of the former wanting to be visited compared with only slightly more than a quarter (27%) of institutional pharmacists and 22% of chain pharmacists. The wish to be visited also varies by geographical area: Only 40% of pharmacists in the East said they want to be visited, compared with half of those in the South and Midwest, and 67% of Westerners.

Visitors welcome?

To dig a little deeper on how receptive pharmacists are to drug manufacturer representatives, we asked pharmacists about their policies concerning rep visits. Overall, 22% limit reps to detailing formulary or new drugs exclusively (see Table 4). In addition, more than a third require, or at least prefer, that reps visit by appointment only.

Table 4
Policies on rep visits

Institutional pharmacists and pharmacists in urban areas are more likely to limit visits and require appointments. Clearly, the Midwest has the most open-door policy when it comes to reps. Only 14% of them limit detailing, compared with 27% in the East, 21% in the South, and 32% in the West. The Midwest is also less likely to require appointments.

Reps are allowed to display or exhibit products on respondents' premises by only 22% of those polled. Pharmacists in rural and institutional pharmacies are most likely to allow displays, and pharmacies in the South are the least likely to do so.

Other policies named by respondents include requiring that all samples be handled through the pharmacy. One R.Ph.—from Cincinnati—said that reps must "sign in" samples, as well as their visits. Four pharmacists observed that they are not allowed to receive gifts or handouts from reps, and one pharmacist from Staten Island, N.Y., limits all visits to one day a week. A pharmacist from Las Vegas commented that reps should visit pharmacists as often as they do physicians.

Importance of rep info

Many pharmacists who see reps indicate that they rely heavily on them for information, particularly product information. Among those who receive visits, 87% rate the product information they obtain from their reps as important. Information on pricing from reps is important to 28% of respondents, although 40% said the information on pricing is of minimal importance to them. Checking stock and handling returns by reps is important to only 12%, and to 68%, these roles of reps are only minimally important. The "social" value of the visits is important to only 12% of respondents, and 62% said the social aspects of rep visits are not at all important to them.

Respondents listed other rep services they appreciate, including providing seminars and continuing education programs, cited by several of those polled. A pharmacist from Fort Wayne, Ind., was much easier to please. He said he likes the free pens. Another, from Chesapeake, Ohio, appreciates the food the reps bring. One pharmacist from Illinois, however, took the trouble to write, "I can't stand these visits."

Rating services, support

Drug companies earned good overall grades for the services and support they provide to pharmacists, although some services are viewed as better than others. When asked what types of manufacturer support most need improvement, more pharmacists (45%) cited funding for continuing education than any other category. Next in line for improvement was disease management (cited by 31%), followed by return-goods practices (29%); customer service (23%); drug information (19%); and, finally, product recalls (12%).

With the exception of funding for CE, however, the majority of pharmacists said manufacturers meet their needs in all categories. Those in the East were less likely to say drug information and customer service needs improvement. The West had the fewest complaints about returned-goods practices, disease management, and funding for CE.

Pharmacists also told us how they feel about the recent trend among manufacturers to distribute drugs through specialty pharmacies. Only 28% feel the practice is fair, and 70% believe that restricted drug distribution policies should be changed to allow all pharmacies to serve as distributors. Those in practice the longest are least in favor of specialty pharmacy distribution.

Drug shortages, counterfeiting

Pharmacists take a pretty dim view of manufacturers' effort to prevent drug shortages and counterfeiting. Nearly nine out of 10 R.Ph.s said drugmakers don't do enough to help eliminate shortages (see Table 5); many respondents offered suggestions on how to resolve this serious problem. A large number feel that manufacturers could more successfully anticipate the demand for drugs and increase production to prevent drug shortages.

Table 5
Combating shortages and counterfeiting

"Use better planning and monitoring of supplies," recommended several pharmacists. "Alert pharmacists earlier of impending outs by way of e-mail, letters, and reps," was one pharmacist's suggestion. And another respondent, from St. Augustine, Fla., advised manufacturers to give pharmacists advance warnings and alternative choices when shortages are expected. "They should use GMPs [good manufacturing practices] so the Food & Drug Administration doesn't close them down," suggested another. One outspoken pharmacist from Illinois expressed a more cynical view: "Drug shortages are manufactured by these companies to bypass multisource contract pricing," he wrote.

As for preventing pharmaceutical counterfeiting, only about half of respondents believe manufacturers do enough to ward this off. Again, suggestions on how to address the problem were plentiful. "Avoid plain white tablets," advocated one pharmacist. Other advice included:

• Develop more control over inventory and distribution channels.

• Use electronic shipping tags.

• Get more creative in the designs.

• Use standard markings and seals.

Selling data to manufacturers

Pharmacists revealed more mixed feelings when it comes to selling drug utilization data (with patient names removed) to manufacturers. Most (81%) respondents have not been approached to sell information. Those who have been asked to share data are fairly evenly divided on whether they want to do so: 52% said they do and 48% do not. Pharmacists in the South and West are much more likely to share data if asked, compared with those in the East and Midwest. Of those who share data, only 27% are paid; 73% are not.

Among pharmacists who have not been approached to sell data, only 22% said they would do so if asked. More than three-quarters (78%) said they would decline to participate. Pharmacists in practice 10 years or less were more inclined to share data, compared with those in practice longer. In addition, women were more likely to say they would share data than were males. Urban pharmacists were also more inclined to say they would be willing to participate, compared with suburban and rural pharmacists.

DTC ads less than popular

Along with obtaining drug utilization data, another increasing trend among manufacturers is direct- to-consumer (DTC) advertising. Although these ads may help increase pharmacy sales, pharmacists still don't like them. Nearly three-quarters (73%) said there is too much direct advertising to consumers; only 26% stated that the amount of promotion is about right. Interestingly, most (74%) respondents said DTC ads would decrease in the future, and only 6% said they would increase. One in five said the rate of advertising to consumers would remain the same.

Pharmacists are also uncertain about the value of cards from manufacturers that offer seniors discounted prices on pharmaceuticals. Nearly half said the cards offer only negligible savings, and about one-quarter believe they consume time for the pharmacist and are a nuisance (see Table 6). Another quarter believe they cost pharmacies money.

Table 6
Views on senior discount cards

On the other hand, 26% said the cards offer significant savings to seniors, and 45% accept the cards in their practices. Only 12% do not. "They would be better plans if all manufacturers participated," commented one pharmacist. "I would like to see one standard card for all manufacturers," said a pharmacist from North Highland Hills, Texas. Another commented that the cards "don't fix the real problem," and one said the cards work well for those who qualify, but that there are too many restrictions on who can use them. One respondent from Wisconsin said the cards may increase drug prices for others, and another noted that his own store's discount plan works better for seniors.

Comments weren't all negative, however. One pharmacist noted that discount cards do "a great job," and another said that they should be available to everyone. Pharmacists in practice less than 20 years tend to believe the cards are good for seniors, compared with those who have been in practice longer. Those in the West and the South are also more likely to view the cards favorably. Not surprisingly, few institutional pharmacists said they accept the cards, but 67% of retail pharmacists do accept them. Midwesterners (62%) are most likely to accept use of the cards, followed by those in the South (50%), the East (44%), and the West (42%).

How can they improve?

When asked how manufacturers could better serve pharmacies, pharmacists had plenty to say. Most of their comments centered on the wish to see fewer drug shortages, lower prices, and more programs and drug information for pharmacists from manufacturers.

Indeed, pharmacists are passionate on the issue of drug shortages. "No more back orders for anything!" demanded a pharmacist from Daleville, Va. Other pharmacists echoed this sentiment. "Manufacturers should anticipate and plan for drug shortages," suggested one respondent. "It really puts us in a bind when we can't get something," said a pharmacist from Eufala, Okla. A pharmacist from Taylorville, Ill., urged manufacturers to "concentrate on supplying the drugs in the market before pushing the drugs in the pipeline."

Said one pharmacist: "One of the hardest things to explain to patients is a drug shortage. They feel we, as pharmacists, are the ones letting them down and we are blamed. We don't have the answer to when the medication will be available."

Feelings about manufacturer pricing also run high. "We are moving toward a crisis on drug prices for everyone. The industry should have to explain why prescribers are provided with breakfast, lunch, and dinner, while consumers must decide between therapy and eating!" griped one angry pharmacist. "They need to cut costs. There's a lot of waste, and consumers pay for it," said another respondent. What pharmacists want can be summed up in two words: lower prices.

Another thing many pharmacists said they need from manufacturers is information. "Manufacturers should provide pharmacists with more information on new drugs," said a Bothell, Wash., pharmacist. "I float between 10 and 12 stores and still get little or no information on new drugs. I'd like to see the info come right to my home address," she added.

Others noted that manufacturers should do more to keep pharmacists informed through the following ways:

• "Provide more continuing education and other programs," suggested a pharmacist from Newburgh, N.Y.

• "Provide more programs on disease management," said another pharmacist.

• "Inform us of recalls before consumers see them on television," commented another respondent.

• "Give information to pharmacists in advance of product distribution so that we can have the information for our patients," a Palm Beach, Fla., pharmacist advised.

In addition to more information, pharmacists also want better information. "Manufacturers should include failed trials in the literature," suggested one pharmacist. "Give us more product comparisons," requested another pharmacist.

"Manufacturers should provide reviews of specific drug categories, such as blood glucose testing products, using objective studies," suggested one respondent. Another would like to see manufacturers keep pharmacists better informed on new products and provide information on their advantages over existing drugs.

Finally, several pharmacists recommended very specific ways in which manufacturers could help pharmacies. "I'd like to see more drug samples for OTC items to promote sales, especially for new items," noted a pharmacist from Lake Zurich, Ill. Other comments included the following:

• "Manufacturers should work with insurance companies to give better reimbursement to pharmacies for our services so we can stay in business."

• "They should have more liberal return policies."

• "Bring us programs to help drive sales and help our pharmacists develop category management plans for their product lines."

• "The labeling and color of tabs and caps should be different for each strength, and containers should have larger openings."

Finally, some pharmacists just want more understanding from drugmakers. Said one respondent: "Manufacturers must remember that without the pharmacist, there would be no one to sell their products." Another pharmacist probably summed it up best, however: "Manufacturers need to understand that community pharmacies must survive."

Debbie Epstein

The author is a writer based in New Jersey.

Debbie Epstein. What R.Ph.s think of drugmakers.

Drug Topics

2002;18:39.