The Wall Street Journal has an article about “unsales,” aka “academic detailing,” aka “counter-detailing.” The basic idea is for health plans to use the same sales techniques as pharmaceutical companies to influence physicians. Only the health plans are pitching generic drugs and OTCs rather than brand name products. They say they are using data that is more objective and evidence based than the drug reps.
There is some merit to these activities. But health plans aren’t unbiased –they just have a different bias. Their bias is to favor low-cost therapies. One physician in the article praised the “unsales” meeting by noting that a drug rep would never say ‘Use Tylenol first,’ as the “unsales” person did. Of course health plans love OTCs considering the patient pays 100 percent of the cost and the health plan pays nothing!
Health plans have a variety of good ways to influence prescribing without resorting to counter-detailing. For example, why not just stop paying for Nexium rather than counter-detailing it? Why not provide incentives for electronic prescribing, which leads to tighter formulary control? Why not provide pay-for-performance bonuses for generic prescribing?
In fact all these things are happening and are proving effective. That’s why counter-detailing is and will remain a fringe tactic: interesting fodder for news stories but not a terribly important tool.March 13, 2006