DTC advertising: A matter of perspective

Whether browsing through magazines or watching television, one doesn't have to look long in order to find a direct-to-consumer advertisement for a prescription medication. Ask a physician, managed care organization or pharmaceutical company about DTC advertising and you'll likely get mixed reviews. DTC ads for prescription drugs that appear on television, in particular, have grown following the release of draft promotional guidelines from the Food and Drug Administration's Division of Drug Marketing, Advertising and Communications in August of 1997.

The guidelines enable pharmaceutical companies to advertise the benefits of brand-name prescription drugs on television, provided they also warn about the most important health risks and side effects. Additionally, viewers must be told what sources they can access for a product's full prescribing information. The FDA's proposed guidelines, for the first time, made brand-specific TV ads for prescription products a practical reality. Previously, the name of the drug and what it was used for could not be mentioned together in the same TV ad without including a detailed summary of the prescribing information. Requiring this volume of information in an ad made it virtually impossible to create standard 30- or 60-second TV commercials.

Recently, IMS Health, a provider of information solutions to the pharmaceutical industry, published a study looking at physician perception of pharmaceutical DTC advertising. In that study, 53% of the respondents stated that they have seen a marked increase in the number of patients requesting specific brand-name medications during office visits. The study further revealed that two-thirds of the physicians reported that the derivation of the brand awareness was from pharmaceutical DTC campaigns. This was an 18% increase from the prior year. These statistics are very troubling for many practicing physicians. This is evidenced by the fact that, according to IMS Health, 64% of the surveyed physicians established that they wanted to see either a decrease in the DTC campaigns or a stop to them all together. The reasoning behind this physician perception is that there is a belief that advertisements for prescription medications are confusing to the general viewing audience. Physicians do not want to find themselves wasting valuable patient time debating whether or not a specific advertised medication is the best course of therapy for the case presented. The medicinal recommendations have traditionally remained with the healthcare provider, not the patient. Ultimately, this leaves the physician feeling pressured into scripting for a medication based on both patient product demand and the doctor's medical knowledge. This represents a role decline in what the doctor feels is an arena that should be driven predominantly by the provider. On the flipside of this perception is the fact that these physicians also feel that there are several positive DTC advertisements focused on prescription medications that not only educate the consumer, but also improve patient compliance.

Managed care weighs in

Managed care organizations have issues of their own with respect to the increasingly popular DTC advertising. They may claim that as technological and medical advances continue to climb, so do their prescription drug costs, which are felt most on the formulary budget. In an age where maintaining healthcare costs is the rule rather than the exception, medication expenditures are representing an increasing proportion of overall healthcare costs. This certainly has precipitated more stringent formulary adherence policies aimed at provider utilization. In another IMS Health study published several months ago, 48% of pharmacy and medical directors stated that they have seen an increase in the amount of requests for approval of non-formulary medications. According to Amy Ertel-Bellcourt, vice president of corporate communications at MVP Health Plan in Schenectady, NY, "The direct to consumer advertising that has really grown the last year and a half has dramatically changed the whole cost containment methodology used by health maintenance organizations. In fact, it probably has been the biggest driver in the development of formularies in HMOs." Ms. Ertel-Bellcourt goes on to state that "consumers are going to their doctors and asking for that more expensive brand which is pushing up pharmacy costs in HMOs somewhere in the 20% to 30% range for 1997 and 1998."

Cost containment is not the only reason why health plans aren't generally supportive of DTC advertising of medications. As more and more patients request specific drugs from their physicians, some health plans may change the coverage for those drugs. This creates an area of dissatisfaction from the health plan member toward the HMO. Consumers don't understand why they suddenly have little or no access to drugs that they had been prescribed to treat certain disorders. Ultimately, this cascade of events causes the insured to become irritated with the plan because it will not offer them their drug of choice. Understandably, this is an uncomfortable position for the HMO.

It is important, then, to understand why pharmaceutical companies continue to support DTC advertising. The reason is simple: This type of advertising is geared toward consumers – individuals who are likely in need of disease-related information and are not discussing their conditions with physicians and seeking appropriate treatment. Some consumers are not even aware that they may have a potentially serious disorder and, instead, settle for inadequate therapy without realizing that treatment alternatives are available. Take, for example, Astra Pharmaceuticals' DTC campaign for the acid inhibitor, Prilosec" (omeprazole), which is the most-prescribed antisecretory drug in America. The TV and print ads are aimed at people who suffer from frequent and persistent heartburn at least two days a week. "The chronic symptoms that these people are having may signal a potentially serious condition called gastroesophageal reflux disease," according to Jim Coyne, manager of public affairs at Astra Pharmaceuticals. GERD symptoms occur when harsh stomach acid backs up into the esophagus, which can lead to damage to the esophagus. "Our intent with the DTC campaign," Coyne explained, "is to increase awareness about the seriousness of frequent and persistent heartburn, its relationship to gastroesophageal reflux disease and available treatment options for the disease. While we encourage frequent and persistent heartburn sufferers to see their doctors for proper diagnosis and treatment, we're very mindful of the critical role of healthcare professionals as the final decision-makers on what constitutes appropriate therapy for specific patients."

In the end, varying opinions of DTC advertising are bound to manifest in different ways. Physicians may feel that they are losing control of a domain that was once exclusively theirs; managed care organizations may choose to restrict access to some medications through their formularies; and pharmaceutical companies will likely continue to educate consumers about diseases and available treatment alternatives. What is important to keep in mind is that, while there may be diverse perspectives on DTC, the common goal is helping to deliver the highest quality healthcare to patients. PR