Today I received a “Dear Doctor” letter from CVS/Caremark under the auspices of Prescriber Services Clinical Information, and something called “RX Viewpoints”.
CVS was taking the opportunity to inform me that Yaz birth control pills are FDA approved for both acne and PMDD treatment, and that Yaz is on the preferred drug list for Caremark. The packet included prescribing info for Yaz and a little article about Yaz. There’s nothing about other treatment options for PMDD or acne. Just a monograph summarizing the studies that got Yaz FDA approved for PMDD and Acne treatment.
There’s also a pad of tear-off sheets for my patients about Yaz, PMDD and Acne. The PMDD info doesn’t really tell patients that they need to have a really lot of severe symptoms to be diagnosed with PMDD. It just lists “some common symptoms of PMDD”, like breast tenderness and food cravings. Reading that list, most women are sure to assume they have PMDD and that Yaz will help them.
The copyright statement at the back of these materials tells me that “this publication is written and distributed by Caremark for the benefit of its clients, the health plan sponsors,” with funding provided by Bayer Pharmaceuticals.
Now I prescribe Yaz, both for birth control and for PMDD, and off label for PMS. I even wrote a review article recently in which I suggested that if a woman has PMS and needs hormonal contraception, Yaz would be a good option for her. So I have nothing against the drug itself.
But this sort of marketing by a drugstore chain for a big pharmaceutical company, under the guise of physician education took me quite by surprise. And, though we docs do a lot of drug talks, most of those are careful to include information about all treatment options for a condition. This article was just about Yaz. Nothing more, nothing less. Drug detailing, pure and simple.
C’mon, why don’t we all just stop playing around? Enough with the smoke and mirrors. Let’s just tell it like it is.
An Honest Dear Doctor Letter
Dear Doctor –
Bayer is trying to corner the market on oral contraceptives. Problem is, their best selling pill Yasmin, just went generic. So they need to get you to stop prescribing that baby and start thinking of their new pill Yaz, instead.
The truth is, we really don’t care what you prescribe. Our main goal here is to increase share price. Coincidentally, that’s also Bayer’s goal. So they figured if they offer us Yaz at a discounted price, we’d help them sell it. Of course, we all know the sweetheart deal won’t last forever. Just long enough for Bayer to get enough new prescriptions for Yaz to corner market share. But that’s okay. Short term profits is what we’re all about. Plus, this year’s Yaz will be next year’s antidepressant, and so on.
To sweeten the deal for your patients, we’re going to put Yaz on our “preferred pill” list. That means your patients will pay less than if you prescribed some other birth control pill thats not on that list. Of course, generic Yasmin would be even cheaper, but we’re not pushing that right now.
Hey! Did you know that Yaz is FDA-approved to treat PMDD? Well it is! Of course, PMDD is the really, really severe form of PMS that hardly anyone has. But Bayer figures, what the heck? Docs don’t know the difference between PMS and PMDD, so you’ll just prescribe the Yaz off label for PMS, right? Not to mention, we’re gonna’ give you this patient handout that will convince every woman reading it that she already has PMDD, which will make the whole thing go much faster for you. By the way, do you know why they call it PMS? The term “mad cow” was already taken. Ha, ha…
Seriously, though, did you also know that Yaz treats acne? Well, it does! We know, we know, so does almost every other birth control pill. But those manufacturers are not the ones giving us a deal right now. Bayer is.
In case you’re not getting enough pressure, Bayer is doing a really nice DTC campaign. So don’t be surprised if your patients come in and ask for Yaz by name. It’ll be your job to figure out “if Yaz is right for her”. But that’s why you’re the doctor, not us! 🙂
So, anyway, long story short. Can you prescribe the hell out of Yaz?
Thanks!
Sincerely yours,
CVS/Caremark and their good friends, Bayer Health
Hehe.
You go girl!
Fabulous!
and that’s just one of the reasons this is my favorite blog.
Don’t think that Bayer is the evil one here. They are completely in bed with CVS – so much so that I can pretty much guarantee that it was CVS that REQUIRED this of Bayer, and then made them pay for it too so that CVS can sell more of Yaz. They probably have a co-marketing deal.
DTC is one way of letting the consumer know that they have options. That’s a good thing, right? Or don’t you want to have a dialogue with your patients about options available to them?
The pharmacy cannot just give Yaz – the doctor has to specify it. Perhaps you can shed some light here as well, doesn’t CVS have to give the generic unless you specify otherwise?
My message to you is this…you have the power and Bayer knows it. You already don’t see reps in your office, so how is it that Bayer should promote their product? They absolutely cannot rely on you to do it, and they have a responsibility to not just patients but to investors and employees around the world. It is not a trivial issue.
Bayer does not have the obligation to inform everyone about other companies’ products, and of the information provided, is it inaccurate? Granted, it’s a bit sleazy to use a less common condition in common venacular.
Since you are the only one who can write the script, I guess that is up to you in the end. It’s good to have power like that.
You know I still think you rock even though I disagree, right?
Schrugs.
I think they’re both dirty. Dirty, dirty, dirty.
You should send that letter to CVS. 😉
Schruggling-
Welcome home from the UK!
You misread me, my dear. I don’t think Bayer is evil. They have a very nice drug there. I prescribe it a fair amount, as I said.
What I can’t stand is the smoke and mirrors – the disguising of drug marketing as unbiased health information sent by a pharmacist, who is supposed to be a health care provider whose client is the patient, but clearly at this point is just a drug marketer whose client is the insurer and Big Pharma. Get rid of the image you have trusted neighborhood pharmacist and replace it with a snake oil salesman and you’ve got the idea. (Not that every drug is snake oil, you know I love my medications, so let’s not go there again, but you get my drift…)
Society’s expectation of healthcare is that it has the patient at the center and that it is free of commercial biases. That’s why everyone is so up in arms about docs taking pens. I think its helpful to point out where the commercial biases lie. In the end, it makes us all better informed consumers.
BTW, what exactly is the busness relationship between Bayer and CVS? Is it just this drug, or broader than that? I’m really curious, and was unable to find anything in my googling of both companies.
Kisses,
TBTAM
So I have a question, please. When I saw one of those commercials, I thought they were advertising Yasmin, just under a catchier (or shorter) nickname. What’s the difference between the two?
PS –
Re your questions, Shchruggling –
1. Yaz does not ahve a generic yet Whch is why Bayer is pushing it. It’s a completely different drug than Yasmin.
2. Re DTC- Actually, mixed feelings on that. Love that birth control is coming out of the closet, not sure I like DTC marketing of drugs in general.
3. Bayer can market their drug by sending me material clearly marked as coming from their marketing department, I can choose to read it or not. If I read it, I know the source and can take it for what it’s worth.
But don’t send me marketing disguised as health information from a pharmacist. Don’t make me have to turn it over and read the fine print on the back to know that it’s really coming from you.
The same goes for medical information on so called medical websites that are nothing more than marketing forums for Big Pharma.
See? You got me on my soap Box…
I’ll get off now.
Bardiac –
Yaz is a lower dose formulation of Yasmin with less placebo days.
TBTAM,
You won’t find the relationship between CVS (and other large retail pharmacies that have driven your local drug store out of business for that matter) on google.
The retailers are brutal negotiators. In order to get onto “the list” of drugs that a retailer will push, you need to incentivize them – big time. They not only need to get a great price on wholesale drugs, but they demand support from the suppliers (via advert $) on things like the inserts you have seen. The drug company is kind of handcuffed. ESPECIALLY for “me too” drugs like the pill. There is nothing so increadibly different about it afterall, so how do you get someone to buy the ethical (industry term, not a satiracal word I am making up here…)version of the drug rather than the generic? You advertise. Anywhere you can.
While I am sure that you read the literature that you get via mail, overwhelming market research indicates that you are in the severe minority. Most people read very little mailed in literature, so they count on reps getting the message across in a live meeting. Since they have no relationship with you or others like you, they cannot sit back and just have faith that you will give due consideration to their drug over others. They have to run the company.
I can understand the snake oil sales thing. The industry has evolved in a negative direction. My personal feeling is that Pfizer started it in an effort to eliminate Merck with Lipitor. They are brutally competitive and cut throat. Merck had put the pharma industry on Wall Street’s radar in the late 80’s and brought with it massive success. They defined the blockbuster. Then the Street required everyone else to copy Merck’s model or be crushed. So the intense sales battle began. Pfizer destroyed Merck in sales and Marketing, and became the world’s number 1 pharma company as a result. Wall Street demands that everyone behave this way or there is a huge sell off of stock. You need to keep in mind that pharma companies have a business module very similar to that of a venture captialist firm, and without the infusion of cash from the street, they die.
When the FDA allowed DTC advertising, the industry spent a fortune on TV and print ads. The result? HUGE SALES and profits. Now you know my perspective here…sales and profits are good. They pay for all the molecules that don’t make it. BUT, in recent years there are far too many examples of shameful ethics invading the industry.
Why has it gone this way? My personal opinion is that with high throughtput screening of molecules for therapeutic value (hundreds of thousands of molecules can be screened DAILY by every large pharma company), there aren’t enough new chemical entities getting to the FDA. So what do they do? Me Toos and line extensions. How do you sell them? By doing what you saw in the insert today. Spin the truth, use the rules to your advantage.
Part of this falls smack into the hands of the FDA that have no real productive working relationships with the industry. They mandate, and do it poorly. They make decisions based on politics, not on good science – they fear decisions. And you will love this one…the greatest conflict of interest…the FDA gets a huge amount of money with each filing. Filing for INDs, clinical trials, and NDAs ultimatey costs millions of dollars in fees to the FDA. So, what does industry do? Exploit the rules. What does FDA do – not a whole lot really.
So in the end, you are rebeling against a system that is really pretty corrupted and frequently forgets about the well being of the patients. They need to behave a bit like this to survive. Sad.
Are they greedy? Yep. Do they sell fear? Yep. But they aren’t alone…
Thanks, TBTAM. Isn’t Yasmin already on a skipping “periods”/continual use type formulation? (I use a different generic with the prescription written for semi-continual use, so I have no clue about Yasmin except what I’ve seen on TV.)
It would be interesting to learn a little about how you folks choose which birth control pills to recommend to someone!
Schruggling –
Wow. Thanks. You’ve pretty much explained the entire pharmaceutical industry in a few paragraphs. WHEN are you going to get to that little blog of yours? Your insights are just so important to the conversation.
Bardiac-
Yasmin has a week off. Yaz has a few days off. The continuous pills are seasonal and seasonique and lybrel (and generics of seasonale, which is probably why they made seasonique)
How do we choose pills? For the some women, things like cost and availability, personal experience, desire for a monthly cycle (or not), desire for “lowest dose”, desire for ring vs pill, what pill samplesa re in the closet, which ones are on formulary or which ones walmart is selling, what pill their roommate takes or what ad they’ve seen on TV may be the deciding factor. I use a gut sense sometimes, depending on what issues I see the patient has and previous experience with that pill among similar patients.
Once a woman has experience with a certain pill, you can use that to guide future pill choices, depending on that pills formulation and what side effects (or not) that she had.
But for a lot of women, though, formulation does matter, and you need to get more specific in deciding which pill to use. Things such as previous experience with a given pill, previous medical or gyn conditions, age, non-contraceptive benefits and side effects come into play. That’s the part where knowing a bit about the different pills can make a huge difference for the patient.
Thanks! Interesting!
Sadly, I fear we’ll see an increase of this type of detailing as more and more pharmaceutical companies are getting rid of their drug reps as a way to decrease costs…
A
as a consumer, i HATE direct advertising of prescription drugs. it cannot possibly be good medicine for someone to “go ask your doctor about the little purple pill” — with that particular ad campaign, which plastered my train station some years back, i had no idea what the purple pill was even for. only that i was supposed to try to score a prescription for it. hey, it’s purple!
the larger picture about marketing and financing of pharmaceuticals is just plain depressing, shruggling.
kathy a.,
Your response is really common I think. It’s a risk that the companies take though, because in general, sales go up with advertising.
The reason why it’s just a purple pill and not a full description of the product (great drug by the way, but just a me too of their own earlier version PRILOSEC which is now generic and OTC, which, before it went generic, was the most successful drug in sales of all time) is due to the rules that the FDA put in place for DTC marketing. If a company indicated what the product is for, then it has to also describe the side effects too. Not so easy to do…the side effects scare off consumers.
I agree that the financing and marketing of drugs is at an all time low – so much so that I think the industry is heading for a serious implosion. It is absurd that it costs, on average, $850 million to get a drug to market. We need new novel therapies for conditions that need treatments and cures such as diabetes, alzheimers, and even knew types of antibiotics. Of course the cancer work has to keep going with the kind of tenacity it has, and my personal favorite, I would LOVE to see antivirals found that CURE viruses. Clearly the industry has failed to delivery new treatments, and resorts to ads to get the current drugs sold.
I am really curious about your response to ads though. Why is it that you and many others, have such a visceral reaction to drug ads? Why not the same to other types of ads like consumer products? I don’t get the same reaction, and I am curious to know why this type of ad gets under the skin of so many. I just ignore them.
It’s an interesting thing to watch from inside the industry. While I don’t participate in the DTC world at all, and neither does the company I work for, I do admire how successful they have been from a business process point of view.
actually, i dislike intrusive advertising for all kinds of products. if i indentify a need, i can search for my options; it troubles me that there is so very much advertising aimed at making people think they need more stuff, lots more stuff.
i think advertising pharmaceuticals is particularly troublesome, though, because it encourages people to decide they have a condition, then talk their doctors into prescribing a particular product — which seems backwards. as TBTAM pointed out, the average consumer is not going to be well-informed about other options that may work as well and cost less.
“it’s shiny! AND it’s on TV!” is not a very good basis for making medical decisions. those kinds of ad campaigns are designed to prey on the easily-influenced, and perhaps on hypochondriacs. sure, it parts them with their bucks, but that’s an advantage for the manufacturers and distributors, not necessarily for the health care consumer.
what an interesting discussion. I see so many angles to this that I don’t know where to begin. I’ll keep it simple.
First, DTC marketing is just another expression of capitalism, which is what contributes to our “free” country. Pharmaceutical companies have finally tapped into this, but I believe have received more flak than other industries (well, outside of cigarrette companies, for instance).
This may be because suddenly people think they need a drug when in fact they really don’t. But again, this isn’t different than other commercials or print ads that make you think you need (fill in the blank).
But the Dear Doctor letter is really a very poor disguise for Caremark’s intent. It would be interesting to see what response you would get if your version of the letter were sent.
well, any one of us is free to buy lottery tickets, or 3 lb. giganto-burgers with cheese and bacon, or feminine protection with wings and odor-guard and sexy-vibes, or neon glow-in-the-dark condoms, or whatever else we want — but none of those products requires a professional to sign off that it is the best thing for us in our particular situations.
just ran across this opinion piece on the very subject: http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/7453357.stm
Totally hilarious!
I don’t really have anything to add to the comments on the original post. But Schruggling’s comment about drug development costs caught my eye. I have a book called “The $800 million pill” by Merrill Goozner. He goes through in fascinating detail the breakdown of those costs to develop a new drug. A shocking proportion of the costs have nothing to do with patient health.
On page 246, Goozner quotes the Global Alliance for TB Drug Development: estimated costs for developing a new drug to TB are $115-$240 million. That’s the actual cost to develop a badly needed drug. $800 million is the cost to develop a drug the company believes it can convince people they want so the company can make boocoo bucks.
I would like to see the government buy out patents at prices determined by how many people would be estimated to receive significant benefit from the drug – so me-too drugs would be worth very little, novel treatments would be worth a lot. I think it would really help set profits in line with benefits to society (which they are definitely not, currently).
I clicked through from Women’s Health News, by the way.
tbtam-
What can I say except, “Well done.”
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