There's a new drug on the market in my field (hell, I could say that every month), so my partner Pissy and I are getting the usual drug rep visits, lunches, glossy brochures, and samples.
I tend to be more sympathetic than most to reps. I understand they have their job, like I have mine. They're just trying to support a family and pay the mortgage like any of us. So, if I have time, I listen politely and sign for samples, and try to give them a few extra minutes if their boss is shadowing them that day.
But this time there's a new tactic me and Pissy haven't encountered before. The reps for this product have all pushed this idea:
"When you send a prescription online, or hand one to a patient, call me with the patient's name and their pharmacy. I will personally go to that pharmacy and demand they order it, so it's in stock when the patient needs to fill it."
So far I've been called on by 3 separate reps for the drug, and all have given me the same spiel. So it's a pretty safe bet to assume the idea is coming from their corporate masters in training sessions.
And no, I ain't doing that.
To me, this is wrong on a couple of levels.
1. Privacy.
Mrs. Patient comes to me hoping I'll keep her health issues a secret. Granted, that also includes my staff, like Mary and Annie, because they have to know what's up.
Her pharmacist is also, at least partially, in the know. They don't have access to my charts, but they know private things about her health from the medications she takes and what she tells them. Which is fine. They're as much involved in her health care as I am. They need to be able to advise her properly about her medications and protect her from any multitude of errors I might make in prescribing stuff (and, for the record, I'm eternally grateful for you guys bailing me out on one in particular last week).
But the drug rep? No. Their job is to make me aware of, educate me about, and convince me to prescribe, their product. Which is fine. But they aren't part of the medical chain between me, Mrs. Patient, and her pharmacist. To give them her name to bandy around Local Pharmacy is, at least to me, a pretty serious breach of her privacy.
Not only that, but my loyalty, and my staff's, and the pharmacist's, are on her side of the equation. We are working for her benefit. The drug rep may claim to be doing so, and some may even believe they are. But at the end of the day, they work for a large publicly-traded pharmaceutical company. Once I give them her info, they have a snippet of personal data on her. Who's to say it won't be used to send her mail about great offers on their other products, and/or sold to clothing companies and banks that want to mail her ads for underwear, new low-fee once-in-a-lifetime credit card offers, or robocall her with great deals on trips to Bermuda?
Obviously, if she gives them this information herself as part of an assistance program or freebie offer, that's different. Then it's her call and informed consent. But I'm not going to.
2. Have you ever watched a pharmacy staff at work?
You don't have to stand there in a creepy I'm-casing-the-joint way, but next time you're at the supermarket, just look over and see what's going on in the pharmacy. Odds are there's 1 pharmacist and 1-2 techs working. At least one of them will be on the phone, the other will be at the patient window or getting something off a shelf, the phone is ringing, there will be lines at both the drop-off and pick-up windows, and some random guy at the counter interrupting them to ask where ketchup is.
They're swamped.
So pretty much the last thing they need in their daily shit storm is for a well-coiffed drug rep to wander in and demand they order & stock their latest and greatest drug (currently $95 a pill per Epocrates), when there's a reasonable chance the patient may never even show up for it. Mrs. Patient could wind up going to a different pharmacy, or find the sample didn't work and she doesn't want to pick up the script, or suffer a nervous breakdown when she hears the price and calms down by strangling the ketchup guy.
In summary, I'm pretty sure the pharmacy doesn't have time for this idea.
I know there are drug reps reading this. Don't take it as an insult. I know you're just doing your job, and that's why I meet with you. I really do appreciate the samples for the product so my patients can try them and see if they're worth fighting with insurance over. Me and Pissy and our staff enjoy the lunches (although if you go to that vegan wrap place again we'll put a restraining order on you).
But don't expect me to betray my patients' confidence to you. You can ask me, if that's what your company requires you to do. I understand that. But don't be too upset when I don't. At the end of the day, I work for their best interests, not yours.
Amen. Our pharmacist are delightful and helpful young men. They do not need anymore stress in their busy day.
ReplyDeleteThank you, Dr Grumpy, thank you.
ReplyDeleteSigned-just a tech
No kickbacks in Grumpyville, just a huge mound of INTEGRITY, which seems to be in short supply in our political realm, sadly. I would absolutely LOVE, LOVE, LOVE a vegan wrap, however. Sounds delicious.
ReplyDeleteI am HIPPA , to what you are saying. But am getting an inkling as to why I got an invitation to buy into Erectile Dysfunction resort and time share Naples Florida.
ReplyDeleteI'm pretty sure that telling a drug rep, who has no direct need for patient care information, which patients are using their drug would be a HIPAA violation.
ReplyDeleteJust their asking may be a violation on their end. Drug reps don't get access to patient records, right?
I'd probably educate the drug rep about HIPPA and the fact you don't wish to pay a fine or be sent to prison just so she can get more commission.
ReplyDeleteJust smile and remind them , HIPPA. Which I am sure they know, but their boss is making them do this little dance. Hand them the HIPPA sheet to give to their boss if they get in trouble for not getting the patient info from you.
ReplyDelete1. HIPPA
ReplyDelete2. Consideration
HIPPA violation, all the way!!!
ReplyDeleteThe acronym is spelled HIPAA.
ReplyDeleteMy peeve, I admit. It's the "Accountability Act."
DeleteThank you. Bad enough insurance gets its slimy paws on my info.
ReplyDeleteBless you, Dr. Grumpy!
ReplyDeleteA retired pharmacist
HIPAA is a joke. Patient data has already been exchanged hands a zillion times via loopholes and flagrant disregard for the limited health privacy protection laws out there, HIPAA included.
ReplyDeleteAnd the government would need to actually enforce the law for it to have any teeth. But doing so is bad for corporate interests, so that certainly isn't going to happen. But hey, at least in this increasingly deregulated, hands-off environment, the stock market is skyrocketing, so good for us little people, right?
But thank you Dr. G for doing the right thing in this instance.
The people that work at my pharmacy are always up to their elbows in work. They never stop moving. They don't need big pharma to give them more work.
ReplyDeleteAt time of my post I count 4 separate people commenting about HIPPA and how these drug reps are violating it. Let's start here - it's HIPAA NOT HIPPA yet you're all (4 and counting) saying it's a violation? And you know this but don't even know the acronym. Ahhhh, the joys of the Internet - and now I'll be labeled a "troll"
ReplyDeleteboy, i'm glad i got here after that "troll" Don. hippa, hippie, hippo for xmas... whatever. (health insurance portability and accountability act)
ReplyDeleteYou got that right, Dr G. No way I'd want my info in their grubby little hands. You're very kind to them too.
ReplyDeleteAs a pharmacist, you can bet your ass that I ain't ordering a bottle of Fukitol unless it's covered (and the patient's portion isn't outrageous).
ReplyDeleteAlso a pharmacist here. Work for one of the big three drug stores. My company DM would prolly kick my butt for ordering a bottle of #30 without running it through insurance first to see what the copay was. 9 times out of 10 if it’s a new drug, it requires a PA. If PA is approved, copay could still be high.
ReplyDeleteHIPPA, HIPAA, hooray for Dr. Grumpy. No one needs their information more available to more sources. It's a nasty marketing technique that needs to stop before it spreads.
ReplyDelete1. My first encounter with HIPAA was when I had to sign in on labels on a clipboard so we weren't publicly exchanging names, but the labels were 6 deep with names on them waiting to be pulled off. Not much respect for HIPAA on my part. Then my first-name-only was called and two of us stood up. Uh huh. That being said:
ReplyDeleteI don't know HIPAA, just a patient here, and any part of it probably means whatever someone wants it to mean at the moment, but is the rep getting razor thin from criminal solicitation?
2. My wife was a tech back in the 90s, and she wasn't afraid of work, but I'll tell you when she quit it was a GREAT present to me. Screw the money. She worked her patootie off at that place (we were in Massachusetts, headquarters in nearby state) and was VERY busy every time I'd drop in to just say hello. I always try to give techs an extra nice word or two -- they earn it. For that matter, I haven't seen many pharmacists just sitting around, either.
"But I went to the vegan wrap place and gave them your name to make sure they always have the fancy brand of teriyaki seitan in stock."
ReplyDeleteHIPPA HIPAA HIPPO...we know what is meant.
ReplyDeleteIf Dr. Grumpy thinks a phone call is in order, he can call the pharmacy himself or phone in the prescription. No need to involve the pharmaceutical company, which is obviously just fishing for patient information.
ReplyDeleteIf I learned that my doctor had given my information to a drug company, I'd be furious.
Hey Dr. Grumpy, as a pharmacist thanks for being one of those great docs to work with! You da bomb!
ReplyDeletePharmacyJim
A drug rep comes into my pharmacy and "demands" I order their product?
ReplyDeleteIt's happened.
We laugh at them after they leave.
Thank you Don, HIPAA, HIPAA, HIPAA.
ReplyDeleteWhatever corporation these reps are from ought to be reported. I've written training spiels for medical device companies and everything we write gets reviewed for HIPAA compliance. This drug company is missing some training.
meanwhile the patient's insurance co/drug plan is telling the patient to go generic or be charged $$$$$.... and what does the average patient know? just causes anxiety and fear about the prescription.
ReplyDelete