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    Confessions of a pharmacy counter-detailer


    Mark E. Greg, PharmD
    Five representatives of different pharmaceutical manufacturers are gathered in the corner of the packed waiting room of a physicians' office. They're busy with shoptalk and the latest buzz. Their laptops, detail aids, and samples are ready for 30-second visits with the "targeted" physicians. They wear the latest fashions and are among the most attractive people I've ever seen. One looks just like basketball legend Michael Jordan. Even I'd like to spend time talking with him!

    How can a skinny, middle-aged, balding guy compete with the pharmaceutical industry juggernaut? Welcome to my world! I'm a "counter-detailer," the pharmaceutical sales representative's worst nightmare.

    The cost-saving strategy of using generic medications as preferred first-line therapy is a no-brainer in light of the lower overall costs of generics over brands. In an article titled "Generic drugs first for millions," published May 24, 2006, Express Scripts noted that every 1% increase in generic dispensing is associated with a 1% decrease in overall drug spend.

    Physician and office staff benefit in numerous ways when they use generics rather than brands, not least of which are fewer nuisance phone calls and faxes from pharmacies, pharmacy benefit managers, and insurance companies.

    Patients like generics because generics save them money. The increased affordability may even enable better compliance. In general, pharmacies appreciate generics as well, since generic prescriptions tend to require the least amount of time to process.

    Birth of a concept

    The term "counter-detailing" was coined in the early 1980s by Harvard physician, author, and researcher Jerry Avorn, MD. In this context it applies to clinically trained pharmacists having face-to-face conversations with physicians to encourage the preferential use of generic medications over brand-name medications in medically appropriate circumstances.

    The counter-detailer works to change the prescribing behavior of physicians. That's what I do.

    Strategic vision recognizes the value that a generic medication counter-detailing program can offer an organization. Advocate Physician Partners (APP), a northern Illinois physician-hospital organization with a membership of 3,600 physicians, recognized the value of such a role and created a dedicated position in 2007. Since then, APP's generic percentages have outpaced those of non-APP physician practices by several percentage points.

    The effectiveness of the program is attributable to access to prescription claims data coupled with the communication of a clear, actionable message, such as "Instead of brand product A, use generic product B as first-line therapy."


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