• by Karl Greenberg , April 18, 2007

As Congress mulls tighter restrictions on direct-to-consumer advertising by pharma companies, drug makers are firing back with studies suggesting consumers and physicians see DTC advertising as a boon to public health.

But a new study by management consultancy Booz Allen Hamilton examining the trend toward so-called consumer-directed healthcare suggests consumers - especially the growing population of those in high-deductible plans forced to pinch pennies - have less trust in messages about drugs from pharmaceutical companies than from other sources.

Still, recent advertising-group or pharma-funded studies say both consumers and physicians find DTC advertising for prescription drugs useful. A 2006 survey of doctors by the National Medical Association (NMA) via an unrestricted educational support grant from Pfizer says, among other things, that direct-to-consumer advertising enhances the doctor-patient relationship. A more recent study by KRC Research on behalf of The Advertising Coalition says consumers value pharmaceutical DTC ads.

Booz Allen Hamilton, which commissioned a Harris Interactive poll of almost 3,000 consumers and 600 physicians in the U.S. to study the retail market in healthcare, says consumers favor independent, rather than traditional, sources of information for healthcare issues. And the study, which culled online surveys by Harris Interactive between June and August 2006, says consumers looking for drug information trust pharmacists as much as they trust their physicians and have a dim view of information from employers, the government and pharmaceutical companies.

Consumers rely on physicians, family, friends and independent sources like Consumer Reports to get cost and quality information and don't trust their health plans for information on where to get good-quality, affordable health care, per the study.

Rick Edmunds, Booz Allen Hamilton vice president, was quick to point out that the studies shouldn't be compared directly. "Obviously, you have to be careful comparing studies of DTC versus 'where do you want to get information around quality and cost'." But he says that, historically, physicians have tended to have a negative view of DTC advertising, though that also depended on the medical condition targeted.

As the NMA study concluded, for example, both consumers and physicians appreciated DTC ads dealing with under-treated diseases.

"Still, in our study, it was quite clear that pharmaceutical companies rated among the lowest in terms of our rating sources of trust," he says. On questions specific to issues around drug price and quality, based on a 1-5 scale, consumers, regardless of health plan, tended to rate information from the government, employers, health plans and pharma "pretty low," he says.

The study also found differences in consumer behavior depending on the level of health coverage. For instance, consumers with higher out-of-pocket expenses and deductibles make choices that are more informed by price of service. Forty percent of consumers with higher out-of-pocket pricing were "very or extremely" likely to change prescription drugs to secure a lower price. Sixty-eight percent say they were willing to go from branded prescription drugs to generics, with 34% saying price would compel them to switch drugs.

Given the skyrocketing price of health insurance and higher premiums and deductibles, it isn't surprising that most of the physicians surveyed -- 55% - expect consumer-directed healthcare to endure, with only 18% viewing it as a passing fad. Nearly nine out of ten physicians expect to see an increase in the share of their patients enrolled in high-deductible plans over the next three to five years.

Physicians believe employers, followed by health plans and patients, have the most to gain in this environment, while about 40% of physicians surveyed think consumer-directed healthcare will have a very or somewhat negative impact on hospitals, pharmaceutical companies, primary care doctors and specialists.

Interestingly, and key to the study, was that, while consumers rely on physicians for information on quality and cost of services, physicians don't consider themselves sources for pricing evaluation. Edmunds says that, particularly with regard to pricing information, doctors ranked pharmacists highest, pharmaceutical companies low, but put themselves almost last in terms of being an appropriate source of information on price of services.

"That's interesting because you have an alignment between consumers and physicians that pharmacists are good sources, but doctors rank themselves high as sources of quality information, but not cost. And consumers, who more and more have to make trade-offs on attributes of quality and cost, need an arbiter; physicians are clearly restraining themselves from that. They don't want to do cost analysis for patients, but that will become an issue as costs increase."

Edmunds says pharmaceutical companies shouldn't be worried about a mass consumer exodus to generics. "People are still looking for quality regardless of the plan they're in."