I do not know if pediatrics is going along with this policy.  I called a
few months ago when the newspaper said Polyclinic was charging $30 per
drug rep. visit as a discouragement, pediatrics still wanted the reps
and their freebies.
Judy Ritchie

http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/d
isplay?slug=polyclinic16m&date=20030116&query=polyclinic

Local News: Thursday, January 16, 2003 
Polyclinic shuts out drug reps, samples 

By Carol M. Ostrom Seattle Times staff reporter 
 
When the Polyclinic in Seattle closed its doors earlier this month to
sales reps passing out their free samples of the latest and greatest
medications, it caused an outcry by pharmaceutical companies. 

But the tough sell, said clinic administrators, was the clinic's own
doctors, 80-plus primary-care and multi-specialty physicians. 

The doctors liked being able to reach for a handful of samples to give
their low-income patients. They liked having samples to give to
patients, knowing they'd start a course of treatment immediately instead
of putting it off. 

Most doctors had grown comfortable scanning expensive brochures touting
new medications, and some argued they had received valuable information
from company representatives. 

Drug companies warned the move, unusual among clinics, would cut off not
only samples but also educational programs. And their trade group argued
that doctors would not get important information about new medications,
including potential side effects. 

But clinic administrators were determined to stop the marketing of
expensive new drugs inside the clinic. "We made a business decision late
last year it wasn't really benefiting our patients, our clinic, or the
community," said Dr. Ralph Rossi, chairman of the clinic's pharmacy and
therapeutics panel. 

The marketing was influencing prescribing patterns, he said, which in
turn were raising health-care costs for everyone. 

For example: Instead of doctors starting out a high-blood-pressure
patient on the least expensive drug, which had a good chance of taking
care of the problem, they started off with the latest — and most
expensive — version, Rossi said. 

Or they prescribed a heavily marketed allergy medication or
anti-inflammatory instead of a generic or over-the-counter drug that
might work just as well. 

He also said the information doctors were getting carefully excluded
studies that weren't favorable or that showed side effects. 

It was like shopping for a car by getting information only from Toyota
instead of from Consumer Reports, Rossi said. 

"I don't begrudge the drug reps from bringing by the studies that are
favorable," he said. "But their hidden bias often makes that information
less valuable than information from other sources." 

Now, doctors will receive their information on medications from
quarterly briefings by a special committee. Low-income patients will get
help processing paperwork to qualify for drug-company programs for
low-cost drugs. 

Some samples will be available to help low-income patients get by until
the low-cost program kicks in. Physicians will be able to request
samples for medications that require demonstrations, such as asthma
inhalers. 

The Polyclinic's move wasn't a surprise. 

Last year, the clinic instituted a "pay per view" policy in which drug
reps had to pay $30 for an hour's access to the doctors. Clinic
administrators then said their visits were disruptive and undermined the
clinic's effort to promote lower-cost drug options. 

Still, when the door was shut on drug reps two weeks ago, many doctors
objected, Rossi said. 

"The hardest thing has been to help our medical staff understand we
needed to change," Rossi said. 

In part, the Polyclinic sought the change because of an agreement with
insurance plans, said Howard Springer, associate administrator. The
Polyclinic has a number of innovative disease-management programs for
chronically ill patients and was looking for ways to pay for them. 

Insurance companies were interested. But the companies wanted a quick
return on their investment and suggested a likely candidate for savings:
spiraling pharmaceutical costs. 

However, there was no incentive for doctors to prescribe less-expensive
drugs because they were disconnected from financial pressures. "We had
the samples. (Doctors would say to patients) 'Try it. If you like it,
I'll write you a prescription.'" Springer said. "It's insidious." 

In the end, he said, the economics of the issue carried the day with the
doctors. 

"This is a very smart group of people," Rossi said. "They realized this
was in the best interests of the clinic. I'm not sure how many like it,
but I believe the vast majority will buy in and will cooperate." 

Carol M. Ostrom: 206-464-2249 or [log in to unmask] 

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