Let me start off this post by stating though I may be critical of certain practices of certain drug companies, I am by no means anti-pharma. Though the pharmaceutical industry is one of the most profitable industries, they bring valuable products and research to the public and the issues surrounding big pharma are far more grey then black and white in my opinion.
That said, I was somewhat shocked when I received a letter from CVS/Caremark about one of my patients. The patient was identified by name, date of birth and medication. The letter stated that this patient was identified by "through CVS Caremarks prescription claims data as having one or more prescriptions filled for metformin or a thaizolidinedione as their only treatment for diabetes." Actos and Avandia are the two thaizolidinedione availabe in the US, and metformin is the most commonly prescribed diabetes pill.
I have received similar notifications before, but usually because patients had only filled one or two prescriptions in a 12 month period for a medication (like the ones above) that they are supposed to be taking every day, thus alerting me to the possibility that my patient may not be taking their medications.
However, this letter was different, because I knew this patient was very compliant with all of his pills. This letter went on to say that I should consider prescribing Januvia for my patients (like the one listed) whose diabetes may not be under control. The bulk of the letter discussed information about Januvia. In very small print at the bottom of the page, it said "funding for this communication was provided by Merck & Co." You don't have to by a doctor or health care industry insider to figure out which company make Januvia.
I have no problems with Januvia. I actually will add this medications to my patients who are on metformin and/or a thaizolidinedione, who are not at a goal hemoglobin A1c of less than 7%. However, it is disturbing that the pharmacy is pushing a drug on behalf of a drug company. CVS/Caremark fills or manages more than 1 billion prescriptions annually through its approximately 6,300 CVS/pharmacy stores across the country. Ironically, the Wall Street Journal just reported that Merck just cut 7200 jobs. Perhaps they feel they can fire their reps, and let CVS and their employees sell their products. This is a bad mix, because both companies profit from prescriptions filled.
It is now well known that the drug companies collect prescribing data on physicians, but they only know what drugs physicians are prescribing and not who they are prescribing them for. Pharmacies obviously know what the doctor prescribes and which patients get it, but it is a privacy violation to share this with the drug companies. By funding promotional material through the pharmacies, the drug companies can target physicians at a patient specific level, bypassing patient confidentiality issues.
Though today it was only a letter promoting a drug attached to a patient who might potentially need it, what's next? Will I be receiving promotional calls from my local CVS pharmacy which seems like a professional to professional communication, but is really a disguised sales pitch? Will the retail pharmacist get a pop-up message when a patient is refilling a certain medication to ask their doctor to prescribe another? We are a free market society, and drug companies have a right to market their products, but the letter I received today is just plain wrong. It might even be illegal.