How I feel about drug reps

So the office I work for is visited regularly by pharmaceutical company reps. Before I started working there, and when I first started, I was pretty unilaterally opposed to that. I tended to think that offices that barred drug reps from their doors were providing better patient care because they weren't under the influence of the drug companies' bullshit. Now that I've worked there longer, I have mixed feelings about it. For one thing, the providers I work for have told me that they take everything the reps say with a few giant chunks of salt -- they're not passive listeners. For another thing, some of the drug reps are in the business to help the patient/consumer -- you can really tell the difference between reps who are in it for the money only and reps who do truly want to help get good treatment to patients.

But my mixed feelings are primarily because letting drug reps into the office provides samples, and those samples can sometimes be lifesavers for patients.

For example, we have a patient who is an insulin-dependent diabetic. He has private insurance, but not very good coverage. I don't think insulin comes as a generic, and it is expensive. One brand of insulin pen, for example, costs around $200 out of pocket for about a month's supply. We give him his insulin -- via samples -- on a pretty regular basis. It's a similar situation for a lot of patients on anti-osteoporosis medication, testosterone gel, sleep aids, and several medications for acid reflux.

Another thing is that insurance companies are ridiculous and, as you know, enjoy denying coverage as much as possible. One thing that you may not know about is the "prior authorization." It works like this: You go to the doctor for, say, acid reflux. You have already tried a bunch of OTC medications and they're not working for you. Your doctor prescribes Nexium, AcipHex, Prilosec, etc. or their generic forms (which are not on the $4 list). The pharmacy runs the prescription through your insurance and they receive a message that says "Requires preauthorization."

This means that insurance will not pay for the medication your doctor wants you to have unless the doctor's office calls the insurance company and convinces them to cover it. It is usually the same deal for MRIs and CT scans. This call takes about 20 minutes for most insurance companies and sometimes takes up to 2 weeks for the insurance company to decide (Medicaid and TriCare are the easiest -- they have one-page paper forms and reply in 1-2 days).

During this time, what are you supposed to do? Your chest is burning, you can't sleep, and you're at your wits end. Answer? Get samples from your doctor.

To me, it's clear that the real problem here is our fucked-up private health insurance system. It would be awesome if there were a national healthcare system that did not "come between doctor and patient" as we hear pretty frequently these days. Even if that system did continue to require prior authorizations, the government model works much, much better than the private model as it stands (and Medicaid and TriCare approve most submissions).

However, since over half the country insists that socialized medicine is Satan incarnate, we're going to keep having evil insurance companies that refuse to cover necessary medications, and as long as that's the case I think it's good medicine to provide patients with samples. Remove the insurance industry and the need for samples it generates, and there's no need for drug companies to insert themselves into offices. And then the drug companies take a big hit too. Everyone wins.