Tuesday, January 27, 2009

An Unfortunate Side Effect of Free Antibiotics

With most drugs, a less costly generic will work just as effectively as the expensive brand name only medication. However, in some cases, this isn't true. Antibiotics is one class of drugs in particular that this can be a real problem.

I would venture to guess that at least 70% of the antibiotic prescriptions we dispense are completely unnecessary. The common cold is caused by a virus. Nearly all upper respiratory tract infections are viral. Bronchitis is usually viral. The Flu is a virus (obviously). We go through ZPaks like water, but most patients don't need azithromycin.

However, there are some cases where antibiotics are warranted. Pneumonia is one of them. One of my coworkers recently was diagnosed with pneumonia. We asked him what his doctor prescribed for him, and he told us he was taking Cipro. The generic version of Cipro is on a local pharmacies free antibiotic list, so he thought it would be a great way for him to save money and get better at the same time.

Any pharmacist should have cringed upon reading that. Yes, we can use quinolones to treat community acquired pneumonia, and while Cipro is a quinolone, you will not see it on any pneumonia treatment guideline. It is not considered a first line therapy for treatment of communitry acquired pneumonia as it has poor activity against Streptococcus pneumoniae (a major cause of pneumonia). Avelox and Levaquin are first line treatments, but those are expensive brand name medications.

This pharmacy's commitment to "help out the public" by providing free antibiotics caused a doctor to prescribe an inferior therapy.

The whole free antibiotic idea is absolutely asinine. It actually does more harm to the public than good. First of all, if you mark something as free, people will inevitably flock to get some of it. It doesn't matter what the product is. We used to get free samples of things like Prilosec OTC, Metamucil, and other various OTC products. Within an hour of putting those things on the pharmacy counter, they'd be gone. You'd see people taking handfuls of stuff even if they've never used it before and had no reason to use it at the time. It was free, so they had to have it.

The same thing applies to antibiotics, except overprescribing antibiotics can have some very dire consequences. Antibiotic resistance is a growing problem, and by giving them away for free, you're encouraging their use in situations they are not merited.

Let's not even mention the fact how pharmacies make absolutely no money off this idea. In fact, the more antibiotic prescriptions a free-antibiotic pharmacy fills, the more money it loses. Remember, they are taking a loss on every antibiotic sold. Yes, it's usually a very small loss, but these are products on which pharmacies used to make a pretty decent profit. I suppose the idea is that people will bring in their other prescriptions along with the antibiotics. We all know this doesn't happen though, at least not to the point of significance. People will chase the free antibiotics just like they chase coupons and gift cards.

The other argument is that it will increase traffic in the store and lead to increased sales in other departments. Maybe that is the case. However, let's just break it down a bit. Say you're a grocery store pharmacy giving out free antibiotics, and let's say that the antibiotics have increased your script volume a little. Although your script volume has slightly increased, your gross profit either stayed the same or went down, so it hasn't helped your pharmacy's business one bit. However, let's say that the entire store's sales increased slightly after implementing the free antibiotic plan. Suddenly, the pharmacy is in a situation where they're doing less business as a percentage of total store sales. Since the corporate guys cannot positively tie the increased store sales to the free antibiotic program, all they see is a pharmacy department with a decreasing gross profit. The pharmacy is making less money, so the corporate bosses decide that they need to cut hours to cope with the falling profit margin.

Now, you're stuck in a situation where you're filling more scripts, making less of a profit, and doing so with less help. The whole store might reap the benefits, but the pharmacy department suffers.

No matter how you look at it, these free antibiotic programs are just stupid. Clinically they lead to poor prescribing habits. Financially, they do more harm than good.


Anonymous said...

Mike, I will let you in on a "secret" about this damn gimmick which you sound like you've at least half figured out anyway. I attended a lecture about a year and a half ago by a guy who coaches independents to grow their business. The original idea is genious if looked at from a strictly business point of view and, more importantly, if executed properly. So here goes... You announce you're giving away the free antibiotics, and people come in to get them. The next point is the critical one which no one does and that's why the whole idea ends up not working to its full potential. When the customer comes in with the prescription, the PHARMACIST, and NOT the techs or interns should be taking in that prescription, start up little talk, basically build a foundation with some kind of interaction that the customer should enjoy. Just as importantly, while taking in their demographics, you should be recording as much of their medical history as possible, not just drug allergies, but the most important thing: Disease States. This is the key to the whole thing.
Once all the info is collected, it is entered into the database... including, and most especially the disease states. The lecturer described databases as being the equivalent of Gold or Platinum in the marketing world. You need to build yours up as much as possible. What you do with it next is up to you, but it's worth a LOT of money, whether used for your own business, or sold to someone else who wants access. In this case, it is supposed to be used internally to then send mailers and fliers to attract these customers back to the store as often as possible. The most lucrative patients are the diabetics if I remember correctly (estimated annual prescription and supply expenses abour $7000-$8000 every year).
So you see, the original idea is a great business generating idea, the problem is no one gets the medical history and the disease states, and rarely does the pharmacist get to interact with these new customers, so they don't end up coming back. Hope this helps you understand it better.

new marvel said...

We learned about first line therapy for community acquired pneumonia a few days ago, and I got excited because I remembered this little rant about antibiotics and did well on the little quiz at the end of class :)

Anonymous said...

3 days of the tincture of time is at least as effective as (and a lot less costly than) a freakin 3 day Zpak.