Drug Reps, 30 Day Free Cards and Hatchet Murder

What could make drug reps even more annoying and obnoxious?  Arm them with little plastic coupons for free drugs, that’s how.

I want to go on record to say that I hate 3/7/10/30-day one-time-use drug freebie cards.  These bane of my profession entitle the member to a free fill of a certain drug.  We input all of the data into our system as if its their insurance, run a set quantity of tablets through, and after cost + $2.50 their “insurance” magically covers whatever the rep is pimping out.

The intention is to replace the act of the doctor getting samples and giving them to the patient.  However there’s a huge reason why I hate these cards and why the drug companies/reps absolutely love them.  In fact, there are a few huge reasons.

Take a bottle of the latest and greatest drug.  Runs in the neighborhood of about $400 for #100.  Now give the patient a coupon for 5 free days.  Who gets to have $380 (or #95 tablets) sitting on their shelf wasting money rotting until they expire (and only get about $150 when they are outdated and returned).  Me.  Not the patient, not the doctor, I get to eat the entire cost of the bottle minus what the stupid fucking coupon paid for.  Sure, maybe if hell freezes over someones insurance may cover this drug, but unless you’re on the state tit (Medicaid) no sane insurance company will cover the latest and greatest without a prior auth.

Now, this brings me to my second point.  Doctor gives them a free month of this shit because some big-titted drug rep sweet talked him.  Completely eludes the doctor that what they are pushing is just two existing (probably generic) drugs that cost pennies shoved into one tablet and given a cool name like CADUET or EXFORGE.  Cool trade names give better results (ask your local drug rep).  Anyway, patient is on this new and greatest drug for an entire month because the doctor gets his/her drug information from walking whores (like getting sex advice from pimps, but I digress) only to (surprise) have the patients insurance NOT cover the drug after the 30 day coupon is used up.  So not only did you piss off the pharmacy by making them stock a medication they will never dispense ever again, but now you need to alter your patients therapy because that little coupon didn’t magically buy them a prior auth. Big Pharma – 1, Doctor/Pharmacist – 0, Patient – 0.

So the take-home message to doctors is to just give the patient samples from your office.  If for some reason the drug company will not furnish you samples (and just these stupid coupons) then throw him/her out of your office (which you should anyways).  That way, if the drug isn’t covered you only screw the patient and not your local neighborhood pharmacy (but call us so we can tell you what IS covered or what we can do to help you continue therapy).

The take-home message to the patient is that these coupons are evil.

The take-home message to drug-reps is that you need to whore out the real goods instead of just pimping plastic cards.  You still may have the wool pulled over the eyes of the doctors, but we’re all onto your bullshit and scam tactics to make us stock expensive shit that nobody will cover.  If you made a GOOD product and sold it at a REASONABLE price, then maybe insurance companies would cover it.  Think about that next time you’re at your million dollar corporate parties.

Comments #

Comment by Steph on 2008-06-20 09:35:16 -0700 #

Four words: “We don’t stock that.”

Comment by one_angry_tech on 2008-06-20 15:44:16 -0700 #

Nine Words: “What if the doctor writes a prescription for it?”
And now they bring us stale muffins.. egads, the insults they reap…

Comment by one_angry_tech on 2008-06-20 15:44:43 -0700 #

And now they bring us stale muffins.. egads, the insults they reap…

Comment by rph3664 on 2008-06-20 19:34:49 -0700 #

Slightly OT: We were discussing Exforge on another website, and we all agreed that it should be used for a drug that treats a tougher condition than hypertension, like ovarian cancer or Parkinson’s or something like that.
The outpatient hospital pharmacy doesn’t take those cards. The customers don’t like it but that’s just too bad.

Comment by DMDMD on 2008-06-20 21:38:26 -0700 #

I’m allergic to prednisone; it gave me an upset stomach. Ha! j/k. I had really bad urticaria. No, seriously. The package insert says 2% of the population is allergic, though I think that number is way too high.
Anyway, I was advised to try Aristocort, and it took almost a week for our high-rolling independent pharmacist friend to find someone who stocked it.
Our friend did >300 TARs/day (pre-auths), at least 800 Rx’s/day, and he wouldn’t stock it even for me. Not that I blame him, though.
Consider this a longer version of Steph’s comment.

Comment by K-pharmD on 2008-06-20 22:04:37 -0700 #

How bout when the drug coupon is for a brand name product that has a generic equivalent? Now we have to order brand name, (for those who work for big chains we get docked for this), then dispense the brand only to have the patient come back next month for a refill wanting brand again. Most likely this is not covered by insurance and costs a pant load. Message to patient: BRAND IS NOT BETTER THAN GENERIC AND WILL ONLY COST YOU MORE MONEY!!!

Comment by RJS on 2008-06-21 06:40:30 -0700 #

I *always* run those things through their insurance before I even attempt to run the card.
“Just to let you know, after this free trial runs out, this drug isn’t covered, so you may want to ask the doctor for something else. It doesn’t make a lot of sense to start a drug, find out it works, and then not be able to continue taking it. The full price is $____”
Most of the time, the patient doesn’t take it.

Comment by returnguy on 2008-06-21 16:43:26 -0700 #

Be glad you’re getting $150 when it expires. If it happens to be an Abbott product you will get $0 back from the manufacturer for the 95% of that $400 bottle.

Comment by Richmond on 2008-06-21 18:38:08 -0700 #

Hey returnguy:
If you are thinking about a certain Abbott product as I am, I would think TAP has no problem emptying those bottles though I suppose he fills more generics…

Comment by DanTech on 2008-06-21 23:16:48 -0700 #

DMDMD said:
“Anyway, I was advised to try Aristocort, and it took almost a week for our high-rolling independent pharmacist friend to find someone who stocked it.”
Aristocort is a brand name of triamcinolone. Why couldn’t you use that instead?
RJS, I always run it through their insurance first because the computer defaults to it. I do warn the patient about the cost and send a fax to the doctor about it.
The worst cards are the ones that save money off of the copay especially those “debit” cards from OPUS. First I have to process the patient’s insurance. Then I have to submit the copays to this podunk coupon that may or may not work. That is double the work and slows me down. I miss the days when drug companies sent patient “checks” for $10 (remember Flonase had them) to be given at the cash register. No muss. No fuss.

Comment by nodrugs4u on 2008-06-22 00:01:18 -0700 #

Has anyone also noticed that these “freebies” almost always stopped working immediately after they are no longer “freebies?”
There is one type out there that’s not too bad. Instead of giveing 7/14/30 free one time, it give a free refill every 3 or 4 times. I don’t mind these. Actually I think the patients will come back for refills just so they can get the free one.

Comment by Crusty RPh on 2008-06-22 06:40:51 -0700 #

If the manufactureres were only doing it for the patient, they would supply it in unit of use bottles. They want us to be stuck with a long dated bottle that costs $400. That’s money in their pocket. I wonder if there is an incentive to the MD to issue the cards. It is good that more of us are just saying no.

Comment by DMDMD on 2008-06-22 12:43:36 -0700 #

Mr. allergic-to-prednisone here. That was many years ago, so I really don’t remember if I was given brand or generic. But, anyway, I was allergic to it too, so HA!
As far as those cards, I guarantee you that 99% of MDs don’t realize that the pharmacy has to order a whole bottle of 500 (or whatever) pills just to fill that one Rx, leading to a loss. I actually worked at our pharmacist-friend for a summer, and never learned that.

Comment by Jonathan on 2008-06-22 19:18:13 -0700 #

My doctor has given me an Axert card. The card worked for six refills. He gave me a new one and I used it again for six refills. Not too bad!
Usually the reps give him sample pills but he ran out and gave me the card as a last resort.

Comment by 2nd Best Intern on 2008-06-22 22:39:59 -0700 #

The only savings card I have seen that I don’t hate are the boniva ones that work like a coupon at the register. Scan it, $20 off right away. No need to screw with the insurance or anything. It is a win win for the patient, us, and the drug company (GSK).

Comment by Doctor David Shultz on 2008-06-23 13:41:03 -0700 #

Those cards are kinda fun when you get a few on the down low and you just blast them through and collect the cash.

Comment by JoRphT on 2008-06-23 20:57:57 -0700 #

Just today I had an argument with a customer over a trial card. Medication normal copay from insurance is 50 bucks. savings card they used reduced it to nothing. The card was a one time deal. Today it went through for 50, with the card giving me a reject of coupon used all ready. Try explaining that to a parent who’s kid is about to cry because they have pimples and that medication works on them. I got, “but the nurse said it works for 3 times”. I printed out the rejection. I printed out the actual cost of the medication. And the parent walked away telling their kid to get a job if they want clear skin. Made for an incredibly awkward time.

Comment by John Deer on 2008-06-24 10:41:07 -0700 #

Crusty RPh said:
I wonder if there is an incentive to the MD to issue the cards.
I read or hear comments like this fairly often. I must be doing something wrong because I have not received a single check from a drug company yet in the 5 years I’ve been writing prescriptions. I did get a bunch of crappy pens that died after 10 days and some pads of scratch paper.
Occassionally I get a lunch(half the time from some place that sucks) in exchange for wasting 15-30 minutes of my time talking to someone who knows nothing about their drug or the disease it treats beyond their talking points.