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The Managed Care-Pharma Interface-Part III: the Pitfalls and the Promise

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Medication Adherence and the Pharmaceutical & Med. Manufacturing (PMM) industry--an opportunity for synergism with health care.

"At the same time that unprecedented progress in pharmaceutical research and development is producing new and better medicines for the treatment and prevention of disease – people are asking tough and legitimate questions about the role and responsibility of the pharmaceutical industry in expanding access to the results of this research."

Raymond V. Gilmartin, the former Chairman, President and Chief Executive Officer of Merck & Co., Inc. (1994-2005) speech, Boston January 19, 2000.  [Note: I can no longer link to the original citation on]

I'd personally be more comfortable if the PMM helped us--the practioners, the pateints and the public, focus more on efficacy, affordability, access and benefit of their products--before their profis and exclusive market share, that is. The following  was originally posted on my blog, "Managed Care 101 in 2010" 1/16/2009 on

"Regarding the pharmaceutical industry's influence on healthcare, I probably have a different view from most about medical marketing. In fact, I am all for the pharmaceutical industry making presentations and visiting me on my turf from time to time. I consider the research they apprise me of, so long as they have had no or at most an arm's length relationship in its sponsorship. In other words, I find that some of the marketing can be useful. However, if a physician is so easily influenced that pens, coffee mugs, and a lunch or dinner to hear a presentation causes that person to prescribe in a certain way, we've got a different problem.

The drug pitch is viewed with suspicion, resulting in the better drug being dismissed for its cost, rather than its cost-benefit. Per a GSK rep, recently, "That a patient with congestive heart failure should be well monitored in an effort to reduce morbidity, keeping them out of the hospital, as it were, is, perhaps, the best example of 'low hanging fruit' for managed care I can think of. It's a no-brainer—deliver better, more accessible, timely care (even after-load reduction) and the patient doesn't crash as easily. In other words, the use of Coreg rather than a alpha OR beta blocker means less cardiac risk." What happens behind the scenes in the HMO's 'Pharmacy and Therapeutics' committee is that the objective evidence is reviewed and if the data are not overwhelming, they go for the cheaper product—every time. It does not matter if the generic tastes horrendous—who's monitoring the compliance, anyway?

Even direct-to-consumer advertising can have value in educating the customer. My point is let's focus on the real issues in healthcare. Making the pharmaceutical industry a scapegoat serves no purpose except to distract us from more important issues. The practitioner must weigh the pros and the cons of any therapy, consider benefit AND cost, be cognizant of trends, standards, and guidelines."

  Reader:  Do you agree that direct to practitioner marking can have net positive value?  If not, please see the Am J Pharmacy Benefits (AJPB at "The Power of the Pen" by Jan E. Berger, MD, MJ

​Also, consider this practical research on the topic of Medication Adherence:

"Adherence increased and remained at high levels with the intervention over the course of the program. Adherence as measured by refill rate improved from 72.7% to 97.9%, a 34.6% relative increase (P = .0016). Average medication adherence for participants, as measured indirectly by call frequency, was 87.62% over the course of the study. Participant feedback was uniformly positive, and a correlation was found between call frequency and prescription refills.

Conclusion: Motivating patients with an automated, intermittent reinforcement platform is a highly effective way to increase medication adherence and limit costs."

Kalayoglu MV, Reppucci M, Blaschke TFMarenco LN, Singer MS. "An Intermittent Reinforcement Platform to Increase Adherence to Medications." Am J Pharm Benefits 2009;1(2):91-94. Published Online: July 01, 2009