Big Pharma targets Nurse Practitioners and Physician Assistants

According to a recent study in The American Journal of Managed Care, nearly 97% of Nurse Practitioners (NPs) now prescribe medications, and each one of these writes, on average, between 19-25 prescriptions each day.  That’s about 6,200 prescriptions per NP prescriber per year. In addition, Physician Assistants (PAs) are writing more than 250,000,000 prescriptions each year.In total, these health care providers are responsible for a significant whack of drug prescriptions each year.

That’s why organizers of the annual Maximizing Relationships with Nurse Practitioners and Physician Assistants Summit provide a platform for the pharmaceutical industry to build cozy relationships with all of these NPs & PAs. Here’s what the summit’s pitch promised: 

“Attendees will interact with NPs & PAs representing academic practices as well as the private-practice settings. The event’s Best Practice sessions and Case Studies show where the pharmaceutical industry has seen growth from developing these relationships.”

Growth from developing relationships is what the rest of us might simply call “big growth in sales revenue”.  Here are the Top Five Reasons to Attend This Conference as listed by organizers in this insider’s pitch to pharmaceutical companies (emphasis mine):

  1. Understand the changes in the healthcare delivery system and the expanding roles of NPs & PAs including their prescribing habits
  2. Learn directly from NPs & PAs during our interactive panels and roundtable discussions on what they would like to see from industry to gain a better understanding of marketing programs
  3. Improve relationships with NPs & PAs which will result in more prescriptions written
  4. Explore better ways to assist industry in minimizing issues when dealing with NPs & PAs
  5. Discovering ways to maximize your Return On Investment by designing specialized marketing program geared towards NPs & PAs

With record numbers of physicians now refusing to meet with visiting pharmaceutical company sales reps to avoid the optics of “marketing-based medicine”, both Nurse Practitioners and Physician Assistants represent fertile ground for cultivating new prescriber  relationships that will in turn help boost numbers for branded drug prescriptions and industry sales targets.

As one former drug rep explained on an online industry forum:

“Many doctors are getting harder and harder to see, if at all anymore. But most Nurse Practitioners will see drug reps. They are usually younger and eager to learn about new and existing drugs.

“Some of my highest (prescription) writers were NPs, and I showered them with goodies and attention. With no disrespect, I found them to be low hanging fruit when I carried a bag.”

Suzanne Gordon teaches at the University of Maryland School of Nursing and is the author of When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession.  As she wrote in the Boston Review:

“Nurses, understandably tired of being overshadowed and under-valued by their physician colleagues, take whatever attention they can get.

“Big Pharma is ready and waiting to give it.

“Some nurses are fighting valiantly to help their colleagues break this growing dependence on Big Pharma. But others are jumping onboard. What they refuse to acknowledge are the consequences of the bargain they are making.”

Georgetown University’s Dr. Adriane Fugh-Berman once observed:

“Drug companies rely on physicians not so much to sell drugs as to sell diseases”.

Drug companies, she explains, frequently engage in campaigns to prepare the way for a new drug or a new use for an old one. An example: the creation of the epidemic of social anxiety disorder” (formerly known as regular old shyness) and the marketing of the drug  Paxil to treat this “epidemic”.

She also suggests that Big Pharma’s proven success at grooming what the drug industry collectively refers to as “thought leaders” or “key opinion leaders” is a natural fit when targeting Nurse Practitioners and Physician Assistants to help boost drug sales by doing paid presentations to their colleagues, funded by industry. (See also: “Is Your Doctor a Thought Leader?”)

According to Dr. Fugh-Berman:

“Here’s how it works. Pharmaceutical-company employees, or specialized vendor services, identify these opinion leaders – influential (or up-and-coming) health care professionals.

“Physicians are the primary target, but as Nurse Practitioners and Physician Assistants become increasingly important in primary care, these hidden prescribers are also being targeted.

“Industry’s influence on NPs and PAs has not received enough attention. For example, the recently passed ‘Physician Payments Sunshine Act’ to monitor financial conflicts of interest between industry and health care providers requires that pharmaceutical companies disclose the cash and other perks they give to physicians, but not those made to other prescribers like NPs and PAs.”

So Nurse Practitioners and Physician Assistants are ripe for the picking. They are the “thought leaders” and “key opinion leaders” in Big Pharma’s future.

As reported in the Wall Street Journal Health Blog, drug companies are using the same marketing tools with NPs and PAs that once applied exclusively to physicians.

Results from that survey published in the American Journal of Managed Care found that:

  • virtually all Nurse Practitioners have regular contact with drug reps
  • nearly all of them have attended industry-sponsored Continuing Medical Education (CME) courses
  • two-thirds hand out free drug samples
  • half have attended a recent Pharma lunch
  • almost two-thirds went to a free Pharma-funded dinner event within the last month
  • 90%  saw nothing wrong with attending Pharma-sponsored events
  • over 60% said accepting small gifts and free meals was no big deal
  • 93% said free gifts from drug reps did not affect their prescribing habits – but in somewhat of a logical disconnect, more than 60% of the NPs thought that distributing a drug company’s free drug samples to patients did encourage them to prescribe that new high-priced (and heavily marketed) brand name drug in the future
But just as physicians have already learned, Nurse Practitioners and Physician Assistants who take money and/or perks from pharmaceutical companies will be able to do so until they stop playing nice with industry.

Dr. Fugh-Berman maintains that these so-called “leaders” – whether they be physicians, Nurse Practitioners, or Physician Assistants – are supported by industry only as long as what they are saying to their peers advances a company’s marketing goals.

“A prescriber who expresses doubts about any assigned product’s efficacy, concerns about its risks, or enthusiasm for a non-marketable lifestyle change (say, exercise) as a superior therapy, will be dropped from a drug company’s speakers list.

“And industry-paid health care speakers are pushing a product, even if they don’t realize it, and health care professionals at industry-funded CME events are listening to marketing messages, even if they, too, are oblivious to this fact.”

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* DEFINITIONS:  

A Nurse Practitioner (NP) is an advanced practice registered nurse who has completed additional training beyond that of an RN, and who works either with or without the direct supervision of a physician. (After six years of legislative debate, Nevada became the most recent U.S. state to allow NPs to practice independently and to set up their own health care clinics). Specific scope of practice varies depending on location, but can include medical diagnoses, treatment, evaluation, and management of acute and chronic illness, conducting physical exams, ordering diagnostic studies, prescribing drugs, counseling and educating patients, and performing/assisting in minor surgeries/procedures. (Here in Canada, three provinces – B.C., Alberta and Ontario) also grant NPs the authority to admit and discharge patients in hospitals and other facilities).

A Physician Assistant (PA) is a healthcare professional who is licensed to practice medicine as part of a team with physicians. A PA can conduct physical exams, diagnose and treat illnesses, order and interpret tests, prescribe medications, counsel on preventive health care and may assist in surgery.

See also:

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9 thoughts on “Big Pharma targets Nurse Practitioners and Physician Assistants

  1. Big pharma is constantly looking to expand its influence. It is getting harder with doctors, so nurses and physician assistants offer “new territory”. Plus they will feel “flattered” to be treated like doctors (rightly or wrongly).

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  2. I deal with NPs & PAs a lot for my homecare patients. You want clinicians to be aware of new meds that might help their patients, but this is a slippery slope. So many drugs are overprescribed and there is usually little monitoring for side effects when a new med is prescribed.

    I also wonder if pharmacists themselves are pestered by Pharma. We have a university pharmacy degree program here, and the students & faculty are great &, try to help local clinicians & doctors review side effects, interactions, etc. But it’s an uphill battle.

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    • Thanks for sharing your perspective here. Make no mistake: drug reps don’t visit docs (or NPs, PAs or any other prescriber) out of the goodness of their hearts. Very lucrative sales technique that works to convince prescribers to push your drug over the competition/generics. For example, from a drug company’s view:

      – favourable change in a doctor’s prescribing habits after less than 1 minute with a sales rep: ↑16%
      – prescribing change seen after 3 minutes with a sales rep: ↑52%

      The effectiveness of this drug rep “education” is well-documented; see more in some of my previous posts (see list above).

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  5. My comment as a practicing Physician in Oxnard CA, is that I am able through the AMA to opt out of having my prescribing published to the industry. Nowhere on the AAPA website does it say that is offered to PA. My PA is certified and of great value to me. She write prescriptions regularly and I was shown by a naive Pharm rep that her prescribing is available . Why is opting out not available to PAs and NPs? Son is a NP

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