How do you solve a problem? Maybe the answer is to throw some money at it. That seems to be the approach Schering-Plough is taking to dealing with the drop in Zetia prescriptions - a 3.8 percent drop in total scrips compared with the same period a year ago and a whopping 17 percent compared with late last year, according to Deutsche Bank analyst Barbara Ryan.
Why the decline? You may recall that the controversial Enhance trial found that its Vytorin cholesterol pill failed to show any benefit over the much cheaper Zocor in reducing plaque in the carotid artery, and even showed a statistically insignificant buildup, although it did a better job of lowering LDL. The results created a debate about the merits of using Vyotrin, which includes Schering-Plough's Zetia and Merck's Zocor.
To cope, Schering-Plough has created a '49 plan,' according to sources who contacted us. For 49 days, or seven long weeks, the drugmaker's sales reps are supposed to schmooze docs - preferably over lunch or dinner - in hopes of convincing them that Zetia is worth prescribing. Over at CafePharma, some reps don't think it will work:
"This is another version of increasing share of voice (SOV) in hopes of increasing prescriptions. Right from the 1990's Big Pharma Playbook. The theory is that if we pound the message enough, doctors will write. We have lost the trust of doctors. It is not the message, but until there is DATA showing that Zetia reduces CV events and mortality, doctors will say that we are just spewing the same old shit, and get even more pissed," one wrote.
A Schering-Plough spokesman writes to say that the drugmaker "has a number of ongoing sales force programs in place to help representatives correct misimpressions and mischaracterizations of Zetia and Vytorin recently presented in the media. While it is Schering-Plough policy not to discuss it’s the details of specific marketing programs, all Schering-Plough programs are in strict compliance with PhRMA guidelines."
22 Comments
The 49 Steps - that was a conspiracy movie, wasn't it?
more like 4 12-step programs and a mulligan
Examine the message Schering is giving doctors by such activities after thier clinical PR nightmare. It is as if they are stating to the medical community, "Hey, our products may not be the best and, being the corporation that we are, we handled the situation void of character and honesty. Also, we are the most fined pharma company in existence. But doctors, we are no different than other comparable companies, so please allow me to buy your loyalty and affection to reassure our shareholders.
It's the old dinner vs data story!
Seems to me this is like any other part of life when relationships are strained. Grown ups talk about it and there's nothing wrong talking in civilized circumstances. Clearly S-P have some issues - although I don't know how damaged their relationships to prescribers really are becaue scrip data tells only part of the story - so what else is there to do? All very well talking about dinner vs data but first, let's assume that doctors are not stupid and actually ask about evidence and available data; and second, any company in the pharma business can discuss only what exists, not what they wish existed. The Enhance study is a nightmare for S-P, but it's not all they have and it's not all bad, but the fallout from its handling was most damaging. Again, what else could be done in the short term?
What do you do when a cheap generic statin is BETTER than your expensive branded combo pill? Buy, Buy, buy - Lunch, dinner, wine, drinks, steaks, lobsters - whatever it takes to 'sell' the doctors. Oh it may be within Pharma guidelines, but make no mistake about it, these are 'soft kickbacks'. What is the motive? Truth or increasing market share? This industry is sick - if the patients only knew.
Dan, you have raised an issue that in many ways justifies the proposal for a national initiative to implement counter-detailing (another topic in PharmaLot). Generic drugs, as you know, are not promoted to physicians because there's no margin to support detailing. It is true that a number of drugs that are now generic are at least equal to, if not superior to, patented products. The problem is that this was not known until after patent expiry. Unfortunately, the patented drugs will continue to be promoted and the generic message will be lost in the noise.
The solution is counter-detailing by independent clinicians (physicians and pharmacists), strong and enforceable drug formularies, prior approval, evidence-based prescribing guidelines and financial incentives to prescribe and dispense generics.
Heretic, By most people's definition a generic is a drug that has exceeded its patent expiration date and is now available to be manufactured and distributed by companies other than the patent holder, or originator. How can it be that prescribers and pharmacists do not already know of the generic's superiority to patented drugs. I suspect they know that perfectly well after using the now-generic before the expiration of its patent. How does this newly-arrived generic become suddenly an unknown product? Times have changed as you probably know. The influence of reps and promotional activities is diminishing all the time. Patients and prescribers no longer drive usage the way they once did, so pharma company's activitiea re less effective. Generic use is driven perfectly effectively and very efficiently, just by other means. I'm not sure your proposals take that into account.
Chris, I see your point and respect your conclusion. As long as reps are creating noise (or share of voice as they call it), generics just don't get the attention they deserve. To a great extent patients are driving generics because they have a financial incentive to look for a therapeutic alternative. The power of detailing is repetition, repetition, repetition. I just don't see that sustained level of repetition for generic alternatives.
(I use generic prescribing as therapeutic substituion, not the substituion of a generic drug that is identical to the branded product)
I hope Congress is watching! The marketing group at Schering-Plough is very brazen if nothing else. Even when the company's integrity has been called into serious question, they decide to resort to tactics that have recently been under fire in several states. I think this even qualifies as downright stupid. Can you call more attention to yourself!
Actually, I believe that the cost of these dinners pales in comparison to the moeny they've been throwing around for years. This group is absolutel;y incorrigible. If the feds go in and check their books, I'm sure they will be in big, big trouble.
Some erstwhile reporter should sign on as an especially attentive waiter.
Are they crazy? The recent ENHANCE fiasco has apparently caused them to lose their minds! I guess that they are all busy making the tough decisions. Desperate times call for desperate measures!
[...] Plough - Zetia: from the ad agency’s waste basket Ed and John have the “Plan 49″ [...]
How sad it is that people still believe everything they read. The "rumored" 49 plan is the latest topic of discussion on the closely watched cafepharma blog. Anyone can post on that blog, including you. I could go on their right now, claim to be an SP rep and say I've known the ENHANCE data since May of 2006. Neither would be true, but I sure would get my kicks watching everyone (including the lawmakers) fall for it. It's the internet people - where 60 year old men pretend to be 13 year old girls....
Hi Piper,
I understand your point. I will say that I spoke with Schering-Plough, which acknowleged the effort is under way. And I included the remarks from the Schering-Plough spokesman in my first post about this topic, which can be seen here. I assume you noticed that.
While it's true that anyone can post on CafePharma, I don't know that should suggest something is automatically true or false. I've been looking at that site for however long and learned, like many people I know, that it contains all manner of uninformed ramblings and worse. I've also learned a few things about the job of the sales rep and, sometimes, doings at this or that company that turned out to be accurate. So the issue isn't all or nothing.
You're free to disagree, but I prefer to keep an open mind, rather than shut the door on anything that may, however infrequently, offer helpful information, of any sort.
Cheers ed
Forgive me if I have misinterpreted things, but it was my understanding that the SP spokesperson only confirmed the existence of multiple initiatives to correct the misinterpretation of ENHANCE/Vytorin in the industry, whereas an un-named source contacted you on the '49 Plan'. Even if SP was to confirm the existence of a 49 plan - that would only tell me that the plan was to be executed in the last 49 days of the quarter, not that they are actually wining and dining doctors - which is unrealistic in itself, given the time constraints on physicians today. Reps are lucky to get in and refill the sample closet, let alone pass on some information to the doctors. In reality, the only people sales reps get reliable face time with is the admin staff. I agree, there is a lot of insight to be gained from reading the commentaries of bloggers. But my skepticism stems from the fact that EVERYBODY knows cafepharma is being watched now. Why would someone, who's compensation is tied to the price of the SP stock, who's livelihood depends on the financial health of the company, go and post such blatantly incriminating things about the company? He wouldn't. Those reps may be bitter, but they also know Congress is onto to site. Talking trash now does more than hurt the company's rep, it impairs their financial security (b/c you don't need sales reps for a product that won't sell...).
Dear Piper,
I thought I was clear in my last comment. In any event, again, I described the plan, as I understood it, including the name of the plan, to the SGP spokesman. He confirmed the plan and gave me the statement you have seen. I assure you that I would not have posted the item, as it appeared, if there was no confirmation. I could have just posted a thread from CafePharma for the sake of it, but that wouldn't necessarily have proven anything, which is the point I believe you're trying to make.
As to your question about what could have motivated someone to post what they did on CafePharma, I can only think to say that it's human nature to gossip. And gossip they do. You make a good point, but beyond that, I'm afraid I can't help you.
I hope this helps, ed
What is very interesting is that there appears to have been no formal response from Schering-Plough, although it seems like Piper either comes from Schering-Plough or another company that may be potentially engaged in similar activities. Given the recent proposed limit of $25 on gifts to docs, I think that many of the marketing and sales plans of Big Pharma companies may be impacted.
Hi Disgusted,
I'm not sure what you mean by 'formal.' There is a response from the Schering-Plough spokesman, which is to say the company had an 'official' reply to my question(s). No press release was issued, however, if that's what you mean.
Hope that helps, ed
[...] for Schering-Plough come despite a sales blitz code-named “49.” According to the blogPharmalot, Schering-Plough reps are spending 49 days (seven weeks) intensively schmoozing doctors — [...]
[...] for Schering-Plough come despite a sales blitz code-named “49.” According to the blog Pharmalot, Schering-Plough reps are spending 49 days (seven weeks) intensively schmoozing doctors — [...]
[...] Congressional investigators are also looking into contributions from the two companies to the cardiology association, which initially asked its members to withhold judgment after the companies released preliminary data from Enhance in January, as well as other efforts to drum up doctor excitement for the drugs. Schering’s “49 Plan,” for instance, aimed to spend $3.5 million over seven weeks — 49 days, get it? — schmoozing physicians over lunch and dinner in order to talk up Zetia. [...]