The impact of denying a direct-to-consumer advertised drug request on the patient/physician relationship

Does price disclosure in pharmaceutical advertising result in price transparency? Evidence from a randomized experiment

Background

Policies that mandate list price disclosure in direct-to-consumer pharmaceutical advertising (DTCPA) cite price transparency among the benefits. The expectation is that price transparency will lead to changes in consumer behavior that will ultimately lower healthcare costs.

Objective

The objective of this study was to assess the impact of price transparency on perceived level of information and consumer behaviors, specifically intentions to seek treatment and intentions to comparison shop.

Methods

A nine-arm randomized experiment was conducted to expose respondents to television advertisements for prescription drugs that varied by price disclosure type (no price/control, list price only, or price plus, which disclosed the list price and typical out-of-pocket cost) and indicated condition (deep vein thrombosis/pulmonary embolism [DVT/PE], diabetes, or rheumatoid arthritis [RA]). The sample was recruited from US adult members of the nationally representative Amerispeak online panel.

Results

The sample included 2138 respondents. For ads featuring prescription drugs for DVT/PE, findings provide no evidence of an impact from price disclosure on perception of sufficient information. For ads for prescription drugs for diabetes, there was no evidence of an impact from list price only, but the price plus group was more likely than the control group to report the ad provided sufficient information (OR = 2.475). For ads for RA prescription drugs, both the list price only group (OR = 3.380) and price plus group (OR = 2.720) were more likely to report sufficient information than the control. Findings provide no evidence of an impact from price disclosure on consumer behaviors (i.e., intention to seek treatment or intention to comparison shop).

Conclusions

Mandatory DTCPA list price disclosure may not be the most effective tool for improving price transparency and affecting consumer behavior.

Primary care physician responses to requests by older adults for unnecessary drugs: a qualitative study

Background

Unnecessary drug use can cause avoidable harm to older adults and is particularly common in primary care, but how primary care physicians (PCPs) respond to older adult requests for unnecessary drugs has not been well studied. This study is to explore PCPs’ responses to requests for unnecessary drugs from older adults, and their influencing factors and potential solutions.

Methods

This qualitative study was conducted through semi-structured, in-depth interviews from January 4 to September 30, 2020 using a grounded theory methodology. A purposive sample of PCPs affiliated with community healthcare centers in Zhejiang Province and Guangdong Province, China were recruited. The face-to-face interviews were audio-recorded, transcribed verbatim, and independently coded by two investigators. Themes surrounding PCPs’ responses to requests for unnecessary drugs, their influencing factors and potential solutions were analysed using a constant comparative approach.

Results

Of the 23 participants involved in this study, 12 (52%) were women and the mean age was 35 years. PCPs frequently declined older adults’ requests for unnecessary drugs through dissuasion, and occasionally rebuffed patients or referred them to another practitioner. PCPs may fulfill requests due to physician acquiescence, patient pressure, or inadequate supervision and support. Participants recommended four potential solutions to improve the quality of prescribing, including developing professional communication skills, enhancing pharmacist-physician collaboration, improving electronic prescription systems, and strengthening prescription management.

Conclusions

PCPs typically deny requests by older adults for unnecessary drugs according to three main patterns, and guidance is necessary to reduce the potential for adverse consequences. Factors contributing to request fulfillment by PCPs require attention, and the potential solutions recommended by participants deserve consideration to improve the service quality of prescribing for older adults in primary care practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01857-x.

Attention to price disclosures in direct-to-consumer prescription drug advertising and the impact on drug perceptions

BACKGROUND

Mandatory disclosure of the price of prescription drugs within direct-to-consumer pharmaceutical advertisements (DTCA) has been proposed as a potential means of curbing rising drug costs in the United States. While price transparency in DTCA has widespread public support, empirical evidence regarding the effects of such drug prices disclosures remains limited.

OBJECTIVES

This study assessed the degree to which a price disclosure was noticed, the individual characteristics associated with price disclosure recognition, and the impact on perceived drug affordability, effectiveness, and safety.

METHODS

A randomized experiment was conducted among 2,138 members of the Amerispeak online panel. Participants were shown a television commercial for a drug treating either type II diabetes, deep vein thrombosis/pulmonary embolism (DVT/PE), or rheumatoid arthritis (RA) that disclosed the list price, disclosed the list price plus the average out-of-pocket cost, or had no price disclosure.

RESULTS

Roughly forty percent of participants noticed when a price was disclosed while 20-24% noticed information about individual costs varying (the higher of these percentages occurred when the average out-of-pocket cost was provided). Attention did not vary systematically with the cost amount. Recognition of the different elements of the price disclosure were most predicted by sociodemographic variables such as race, education, and income as well as health characteristics. Price disclosure altered perceived affordability of the advertised medication in a manner consistent with the costs provided, but such consistent significant effects were not found for perceived drug effectiveness and safety.

CONCLUSIONS

Repeated exposure to price disclosure in television DTCA or supplementary sources of price information may be necessary to increase attention to drug price information, especially among those who are most vulnerable to the burden of drug costs. Price transparency appears useful for adjusting affordability perceptions, but additional research needs to examine how such perceptions factor into healthcare decision-making and drug pricing.

Trends and effects of pharmaceutical DTCA

Purpose

The purpose of this paper is to investigate the current trend of pharmaceutical direct-to-consumer advertising (DTCA) in the USA and its effect to patients, physicians and drug utilization. The DTCA of pharmaceutical firms is defined as an attempt of pharmaceutical companies to advertise product directly to patients.

Design/methodology/approach

The methodology used is literature review complemented with a semi-structured interview.

Findings

Pharmaceutical DTCA showed a reduction in total spending, whereas the online channel experienced growth. DTCA affected the physician–patient relationship and patient satisfaction. Patients who received medication associated with DTCA showed higher satisfaction. DTCA of second-line drugs resulted in an increase of first-line drug utilization. Benefits of pharmaceutical DTCA include enhancing appropriate drug utilization and increasing awareness. DTCA might cause harm by interfering with physician’s decisions regarding drug choice.

Research limitations/implications

Limitations include limited available information of DTCA spending from pharmaceutical companies and lack of quantitative data on the effect of pharmaceutical DTCA. In addition, DTCA is sometimes affected by research bias.

Practical implications

Improvement in the physician–patient relationship and patient satisfaction, as well as in the quality of care provided may be demonstrated.

Social implications

Pharmaceutical firms using DTCA marketing advertisement methodologies can increase awareness of underdiagnosed conditions and affect medication costs and the utilization of appropriate drug utilization.

Originality/value

Review highlights current relationships between DTCA, patients, physicians and drug utilization to explore the effects DTCA on consumers.

Direct to consumer advertising of robotic heart bypass surgery: effectiveness, patient satisfaction and clinical outcomes

Purpose

Robotic coronary artery bypass (rCABG) is a relatively novel and less invasive form of surgery. A yearlong direct-to-consumer advertising (DTCA) campaign was initiated to provide the community with information regarding rCABG, increase awareness and recruit patients. To optimize information content and ensure appropriate messaging for future campaigns, this study aims to analyze the campaign effectiveness and compared service quality perceptions and clinical outcomes, following surgery across DTCA-responder and control groups.

Design/methodology/approach

The institution initiated an rCABG program and one-year DTCA campaign. The authors prospectively documented all rCABG referrals prompted by these ads (DTCA-responder group) and concurrent referrals from medical providers (controls). Groups were compared according to baseline characteristics, perioperative outcomes, patient satisfaction (HCAHPS survey) and functional capacity at three weeks (Duke Activity Status Index). At six months, both groups were surveyed for patient satisfaction and unmet expectations.

Findings

There were 103 DTCA responders and 77 controls. The subset of responders that underwent rCABG (n = 54) had similar characteristics to controls, except they were younger, less likely to have lung disease or to be scheduled as an urgent case. Both groups had similar 30-day clinical outcomes, functional capacity recovery and overall satisfaction at three weeks. Follow-up interviews at six months and four years revealed that the DTCA group reported more unmet expectations regarding the “size of the skin incisions” and “recovery time” but no concern about “expertise of their surgeon”.

Practical implications

The DTCA campaign was effective at recruiting patients. The specific focus of the ads and narrow timeframe for decision-making about CABG lends confidence that the incremental cases seen during the campaign were prompted primarily by DTCA. However, differences in unmet expectations underscore the need to better understand the impact of message content on patients recruited via DTCA campaigns.

Originality/value

This is one of the first studies to provide real-world direct empirical evidence of patients’ clinical and attitudinal outcomes for DTCA campaigns. Furthermore, the findings contradict prevailing beliefs that DTCA is ineffective for prompting surgical referrals.

Communicating nutraceuticals: A multi-stakeholder perspective from a developing nation

Nutraceuticals, a combination of nutrition and pharmaceutical, have grown rapidly as a product globally. Nutraceuticals can be advertised directly to consumers as well as prescribed, and thus involve multiple stakeholders in the marketing communication process. The present study investigates the marketing communication aspects of nutraceuticals using 216 semistructured in-depth interviews including all stakeholders in the process such as company/brand, physicians, pharmacists, and consumers. The findings bring out the role of each participant in the communication process and a comprehensive picture of the same. The insights would facilitate the nutraceutical brands to understand and implement marketing effective communication strategies.

Do consumers perceive their doctors as influenced by pharmaceutical marketing communications?

Purpose

– This paper aims to explore whether and how consumers perceive the impact of pharmaceutical marketing on their own doctor’s prescribing behaviors, and subsequent responses toward their doctor’s advice.

Design/methodology/approach

– Three experimental studies were conducted. Studies 1 and 2 are based on text-based manipulations and undergraduate student research participants. Study 3 uses image-based manipulations and average adult consumers.

Findings

– Study 1 demonstrates that consumers can be quite skeptical about their doctor’s motives for prescribing certain brand-name drugs; in particular, consumers can construe doctors as agents of persuasion for prescribed brands. Study 2 shows that this can result not only in choosing generic drugs over prescribed brands but also in opting out of pharmaceuticals altogether by choosing alternatives like natural remedies. Study 3 further demonstrates that these effects can be easily triggered by visual cues in a non-student sample.

Originality/value

– This research builds on the existing literature on pharmaceutical marketing communications, and extends the theory of persuasion knowledge into healthcare settings.

Literally experts: expertise and the processing of analogical metaphors in pharmaceutical advertising

This research examined differences between novices and experts in processing analogical metaphors appearing in prescription drug advertisements. In contrast to previous studies on knowledge transfer, no evidence of the superiority of experts in processing metaphors was found. The results from an experiment suggest that expert consumers were more likely to process a metaphor in an ad literally than novices. Our findings point to a condition in which the expertise effect with processing analogies is not the linear relationship assumed in previous studies.

Impact of oncology-related direct-to-consumer advertising: association with appropriate and inappropriate prescriptions

BACKGROUND

Little is known about the impact of direct-to-consumer advertising (DTCA) on appropriate versus inappropriate prescribing. Aromatase inhibitor (AI) therapy for breast cancer provides an ideal paradigm for studying this issue, because AIs have been the focus of substantial DTCA, and because they should only be used in postmenopausal women, age can serve as a simple surrogate marker of appropriateness.

METHODS

Data regarding national DTCA spending for the AIs were obtained from TNS Multimedia; hormonal therapy prescription data were obtained from IMS Health. Time series analyses were performed to characterize the association between monthly changes in DTCA spending for the AIs and monthly changes in the proportion of all new hormonal therapy prescriptions represented by the AIs from October 2005 to September 2007. Analyses were stratified by age, considering prescriptions for women ≤ 40 (likely premenopausal) to be inappropriate and those for women > 60 (likely postmenopausal) to be appropriate.

RESULTS

Monthly dollars spent on AI-associated DTCA varied considerably ($118,600 to $22,019,660). Time series analysis revealed that for every million dollars spent on DTCA for the AIs, there was an associated increase 3 months later in the new AI prescription proportion of 0.15% for all ages (P < .0001) and 0.18% for those > 60 years (P < .0001), but no significant change for those ≤ 40 at any time from 0 to 6 months.

CONCLUSIONS

DTCA for the AIs was associated with increases in appropriate prescriptions with no significant effect on inappropriate prescriptions, suggesting that DTCA may not foster inappropriate medication use for certain drug classes.

Prescription drug request and denial

Purpose

Prescription drug requests and physician denial are important aspects of medical decision making, but little research has been done to identify factors linked to prescription drug request and physician denial. This paper aims to explore factors in relation to patient prescription drug request and provider denial.

Design/methodology/approach

The paper is based on a cross‐sectional study in a nationally representative database of 2,988 individuals. Descriptive and multivariate stepwise conditional logistic regression analyses were conducted.

Findings

Results of multivariate regression models reveal, after adjusting for personal factors, that heart disease, allergy, anxiety, minor chronic conditions, medical seeking behaviors and direct‐to‐consumer advertising (DTCA) were found to be related to prescription drug request. The denied were individuals with arthritis, less prevalent chronic conditions, the uninsured, and African Americans. It was also found that 27.4 percent of the sample requested a prescription drug and about 24 percent of those who segmented for prescriptions were physicians.

Research limitations/implications

DTCA is positively associated with prescription drug requests but the analysis did not support any effect of DTCA on the refusal status. Patients' requests and physician decision making to refuse are somewhat complicated and vary with different medical conditions.

Originality/value

The paper, using nationally representative data, investigates the factors associated with prescription drug request and denial.