Story and photos by BERKLEE HAMMOND

Effective May 1, 2019, Intermountain Healthcare has prohibited industry-based pharmaceutical representatives and medication samples from entering practices and hospitals throughout Utah. 

Intermountain believes this new change will increase patient safety, refine adherence to clinical guidelines, improve prescription patterns, decrease cost of medicines and eliminate operational complexity and burden.

According to a statement by Dr. Mark Briesacher, senior vice president of Intermountain Medical Group and Medical Staff, this change has been made to fulfill Intermountain Healthcare’s vision of being “a model health system by providing extraordinary care and superior service at an affordable cost.” 

Pharmaceutical representatives received a document titled “Removal of Pharmaceutical Representatives and Medication Samples from Intermountain Clinics” issued by Intermountain Healthcare. The document explains why samples and pharmaceutical reps are no longer permitted. It also states that patients are commonly given verbal instructions about appropriate use of medication samples and side effects.

This can lead to product labeling and written patient instructions that are often inadequate. These new regulations will decrease the chance for medication errors and improve patient safety.

Intermountain plans to improve adherence to clinical guidelines by removing pharmaceutical representative visits, samples, and marketing. According to a statement released to pharmaceutical companies, Intermountain would do away with professional and social pressures and would allow physicians to make unbiased decisions on behalf of their patients. 

This document explains how these steps will improve prescription patterns for patient care. Eighty-three percent of prescription promotion is done by physicians who have been educated on drugs from pharmaceutical representative visits. 

According to a 2014 study of 150,000 physicians over a 24-month period showed the detailing impacts selective, brand-specific demand and influenced prescribers. 

Intermountain Healthcare cited numerous studies that have shown physicians were three times more likely to prescribe a generic product when samples were removed from clinics.

The Medical Group Service Line’s statement indicates the changes at Intermountain will eliminate operational complexity and burden. Storage, distribution and security of medications is challenging to manage and increases the expense on care teams.

HOW WILL THIS AFFECT THE PHARMACEUTICAL INDUSTRY?

The reason behind this decision came after leading healthcare organizations like the National Institutes of Healthand the Institute for Safe Medication Practicesrecommended against utilizing pharmaceutical representatives and samples because this has a negative impact on patient safety, care quality, and costs. 

Crystal Goodrich, a local district manager of a pharmaceutical company, explained the small steps that eventually led to the new regulations.

First, she said the changes started when Big Pharma companies agreed to discontinue distributing any type of promotional materials such as sticky notes and pens to any healthcare entity. Goodrich said, “Some rules made sense.” 

Intermountain was among the other healthcare agencies that did not want their physicians being influenced by promotional materials. 

The Big Pharma agreement, including Intermountain, later prohibited physicians from going out to dinner or to special events with representatives. Goodrich remembers, “This was when the pushback from physicians started across the industry.”

According to Goodrich, Intermountain then took restrictions to another level.  Intermountain only allowed one appointed representative from each of the pharmaceutical companies statewide to have access to any and all of Intermountain’s approximately 5,000 physicians. 

Rebecca Nixon was assigned to Intermountain Healthcare exclusively as a representative 10 years ago. Nixon only visits Intermountain’s practices and clinics.

Nixon explained the adjustment from visiting clinics from all Utah healthcare entities to going exclusively to Intermountain. She shared frustration in the lack of competition in Utah with Intermountain and lack of authority from Intermountain Healthcare physicians. 

Nixon said, “The doctors are employed by Intermountain Healthcare, they are not in charge or able to make these decisions themselves.”

She said these new policies from Intermountain Healthcare will affect her job tremendously. She is now going to be reassigned to another position due to the regulations set by Intermountain Healthcare.

As of May 1, 2019, there is a new level of restriction. If a representative enters a clinic, Intermountain Healthcare urges physicians and administrative staff to not accept any medication samples, coupons, literature, vouchers or other forms of drug marketing.

Both Nixon and Goodrich stated that physicians at Intermountain Healthcare have pushed back with these new regulations. Due to the pushback, Intermountain Healthcare has now made an exception to lifesaving medications like inhalers, blood thinners and several other medications from drug representatives.  

Intermountain Healthcare physicians will now get their education from pharmacists instead of trained pharmaceutical representatives. “This certainly concerns us,” Goodrich said. Pharmacies make more revenue from generic brands than name brands. This raises concern for patient care.

“A big concern is knowing physicians at Intermountain valued our knowledge and they can’t get it anymore,” Goodrich said. Pharmaceutical representatives spend weeks, months and years becoming trained on the medication they represent. They get trained through in-person trainings, online training and continual training by district and regional representatives that monitor the accuracy of the information distributed.

This training will now be the responsibility of each physician. They will need to take the time to educate themselves on hundreds, even thousands, of medications to provide accurate and informed education to each patient. 

According to Intermountain Healthcare’s website, this not-for-profit system has more than 5,000 physicians who are affiliated with Intermountain, including about 1,400 employed physicians in the Intermountain Medical Group who provide care to patients at more than 185 clinics and offices as well as 23 hospitals.

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