Thursday, February 02, 2006

Under Investigation: Novo Nordisk's Insulin Marketing

The New York Times recounted allegations of questionable marketing practices by Novo Nordisk.

Novo Nordisk had been competing vigorously with Eli Lilly for its share of the insulin market. (For some idea of Lilly's marketing tactics, via Pharma Gossip, see this link.) In doing so, according to the Times, the company used two related, problematic tactics.
  • Novo Nordisk forged an alliance with Rite Aid, the US retail pharmacy chain. Top Rite Aid executives wrote their pharmacists that "Each Novo Nordisk product we dispense brings us 20 to 40 percent better profit margins." Ms Susan Jackson, a Novo Nordisk spokesperson was quoted in Diabetes Health as saying Rite Aid pharmacists "will actively intervene to introduce Novo Nordisk products." There is evidence that at least one Rite Aid pharmacist, Lawrence M Schulz, was paid directly by Novo Nordisk. The Times reported that "Mr Schulz or a pharmacy technician then contacted doctors to persuade them to switch their patients to higher-priced insulin products, according to three former sales representatives. It is not known why doctors agreed to the changes, but the sales representatives say that they may have assumed the switch was required under the patient's insurance policy." Ms Jackson countered that the agreement with Rite Aid "has benefited many people with diabetes." Karen A Rugen, a spokesperson for Rite Aid, said "our alliance with Novo Nordisk is standard industry practice."
  • Novo Nordisk also instituted an "anchor" program to establish "contacts in some medical offices that served many diabetics, three former sales representatives said," according to the Times. "The contacts were generally nurses or medical assistants responsible for monitoring diabetic patients. Officially, Novo paid the 'anchors' to educate patients about Novo's products." However, "two of the three former sales representatives who participated in the program said that Novo paid anchors as much as $25 for each prescription they helped switch to higher-priced insulin products."
Novo Nordisk is now under federal investigation for "possible criminal violations." The Times suggested that it is possible that the practices above violated "federal anti-kickback statutes [which] prohibit [pharmaceutical companies] from offering financial incentives to doctors or pharmacists to enourage or reward the prescribing of particular drugs...." (The announcement by Novo Nordisk of this investigation is here.)
The Times quoted David R Work, executive director of the North Carolina Board of Pharmacy, "these switches have nothing to do with patient interest, they're all about money." Carmen Catizone, executive director of the National Association of Boards of Pharmacy added, "we are opposed to plans where the financial interest of the manufacturer takes precedence over the patient's health. To call a physician and say we're changing a patient's medication and make it seem as if it's on behalf of the patient when it's actually part of this marketing deal is not right."
File this one under deceptive practices used to market pharmaceutical products. This is another illustration of the complicated web of conflicts of interest that now entangles much of health care.
In my humble opinion, to put patients first we need broad solutions that address conflicts of interest throughout health care. We need to address such conflicts regardless of whether they affect doctors, nurses, pharmacists, or managers, and regardless of whether they come from pharmaceutical and device companies, medical IT providers, managed care, etc, etc, etc.

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