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May 2008

Industry intelligence in association with STAR

Non-prescribing opinion leaders now have a significant influence on whether your product will be prescribed. This month, Customer Insights profiles Public Health and Medicines Management. Pf speaks to Alison Tennant, Head of a Medicines Management Team in Dudley, West Midlands and a Specialist in Pharmaceutical Public Health.

Please describe your role

My Medicines Management work gives me an operational involvement in GP prescribing budgets, while the Public Health position has a much wider remit. The idea with the Public Health role is that we look at population impact. I look at two elements: what value for money are we getting from our current prescribing budget in terms of health gain, and what new innovations are around the corner that may help improve it? The latter is classic horizon scanning. For example, when we knew that we had to implement NICE guidelines for Herceptin, we didn’t just look at the cost of the drug, we looked at the change that was going to need to happen to services in order for the drug to be used.

How does the process work and how does this impact pharma?

Traditionally, a new drug comes out and we issue prescribing guidelines that advise GPs on how to use the product – or not to use it at all. More often than not, we have to base those decisions on clinical data. What we are trying to get drug companies to look at is what impact their drug is going to make on the whole health economy. For example, some drugs for osteoporosis have meant a large investment in the prescribing budget but a lot of savings elsewhere. The improvements are actually seen in the social care budget through reduced hip fractures. Drug companies need to focus on the outcomes that improve the health of the patients their product targets. Where is the evidence that it works? Where is the evidence that the improvement it makes is important to the patient? If it’s about reduced side-effects, how many patients currently experience those side-effects and to what extent does it bother them? And critically, what are we going to get out of this drug in terms of reduced appointments, improved compliance and benefits elsewhere? I always look for a budget impact model – these are getting better and are very useful. For example, a company contacted me about an inhaler that was intended to reduce admissions to hospital with COPD. They had data which showed that patients using the drug went into hospital less. This is extremely valuable as this kind of modelling helps us give robust advice to GPs trying to manage PBC and their prescribing budgets.

What should the industry be considering when developing its messages?

The problem for the industry is that every PCO is different. My patch, Dudley, for example, is beautifully simple: there is one district general, one local authority and one PCT. This creates a very straightforward health economy. But other territories are much more complex. So because of this, it’s primarily important for a drug company trying to interact within such a varied framework to identify and understand at what level their drug is going to be prescribed: is it going to come from tertiary care, secondary care or primary care? Then, once you’ve established that, who are your key influencers? One of the major challenges for industry is that, for optimum success, they need to come and talk to the PCO first before knocking down the doors of their target GPs. The problem is, it’s so difficult to get an appointment to sit in front of people in my position, and so the natural reaction is instead to drum up interest among clinicians. This does have a value but ultimately, to unlock funding, messages need to be heard at PCO level.

Most of the time there is a problem with drug companies bombarding clinicians, and sometimes the cart is pulling the horse. Secondary Care clinicians are still very influential and, as such, the industry builds up a head of steam by taking clinicians to conferences. The consultants return really excited about a new drug they have seen a presentation on and are keen to start using it. More often than not, I might have read about the therapy while horizon scanning, but there are no published papers. Without evidence, we can’t support a product. The problem for us is that we’re constantly known as the cost police. People believe we are simply thinking about money.
But we’re not, we’re thinking about what do you get for your money?

Is there anything the industry can do to change this perception?

One of the things I have been pushing the industry to do for some time, because I think they have more of the muscle to do it, is to get the consultants to understand what is happening in primary care and the fact that
they can no longer just do what they like. The consultants need to be educated. My view is that if they don’t understand where we are coming from they are not going to be able to align the message – and that’s not just the drug industry, that’s the clinicians as well. Secondary care clinicians need to understand what the PCT is trying to get out of a new treatment or a new drug, then it makes life easier for them. Clinicians need to understand the political arena within which they are working.

How can the industry overcome the issue of communicating with PCO decision-makers?

It is difficult, but it can be done. The locally successful companies manage to do it by actually telling the clinicians that they need to speak to the PCT. So actually, yes, they build up a head of steam from the clinicians; but they know the PCT processes, so (the clinicians) say they will drop a line to the PCT to say we have been talking to you (drug company) about this and how it is going to be used and where it is going to be of benefit. Where the company has a mature history in our patch and they know the clinicians well, this has worked. But it doesn’t always. The problem is that sometimes the approach has to be different according to what type of drug it is. You need to look at what type of drug this is: is it primary or secondary care? What sort of impact does it have?

Are there any other options to reach you?

If a company can’t get an appointment with me then I may get invited to an educational meeting, or a health economy meeting where a consultant is speaking and they know I will go along… and go into combat and negate whatever message the consultant is giving out! Or they will invite me to come along and talk about a drug.

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