Tracking doctors' prescription habits for marketing purposes: Does it adversely affect prescribing decisions and cost?

Health information organizations (HIOs) purchase prescription records from patient points-of-sale, then aggregate them to create prescriber-identifiable prescription profiles used primarily for targeted marketing efforts by pharmaceutical marketers. Regulators in the United States are concerned that this practice increases prescription drug spending, and degrades the quality of prescribers' decisions; claims that pharmaceutical marketers and HIOs say lack support. This study performed a multidisciplinary review to determine whether there is evidence to support the assertions of regulators. Published data from the fields of public health, economics, medical anthropology, and business reveal compelling evidence supporting the concerns of regulators. Prescription tracking enhances the effectiveness of the marketing practices of detailing and sampling. Both detailing and sampling have statistically significant, positive effects on prescription rates, and they change prescribing practices, resulting in higher cost, higher rates of non-rational prescribing, lower rates of generic prescribing in favor of newer, more expensive drugs that do not necessarily demonstrate clinical superiority. Sampling and detailing also result in quicker adoption of new drugs, often before their safety profiles are fully understood. In the United States, $20 billion is spent on detailing and sampling each year, garnering an estimated ROI of $1.72 (range: $1.27 to $10.29). The increased cost to payers is not known. With the widespread acceptance of direct-to-doctor marketing of pharmaceuticals, both in the United States and abroad, public health regulators need to consider the impact that technology-enabled marketing practices may have on prescriber decision making, the public health, and the financial wellbeing of health systems.