When
I first started writing this series on Pharmacy Practice, I drew
from the best practice features that I had observed, or had utilised
personally. The practice model I have evolved through these writings
remains the foundation on which to build the pharmacy of the future,
but unless it is being continually refined, or enlarged to take
advantage of opportunity, it will develop "hardening of the
arteries" and become inflexible and non-competitive.
TrialCard is a system presenting a new opportunity.
Like most new systems, it builds on an old method, and this one
involves the delivery of drug samples, long a bone of contention
to pharmacists around the world.
Each sample pack given out is a script loss to a pharmacist.
Each sample pack received by a pharmacist is a potential profit,
if it can later be utilised in a prescription, which is why they
are currently distributed through doctors only.
TrialCard Inc is an American company that specialises in the delivery
of coupons and samples for pharmaceutical companies, and does it
via a magnetic stripe card. The cards can be adapted to all pharmaceutical
computer systems.
So imagine the situation where drug manufacturers actually ask pharmacists
to utilise their existing stock as samples to supply to patients
at no charge. Then be reimbursed by the same drug manufacturers
for their product cost and time in patient counseling. And this
entire process being driven by doctors who initially distribute
a TrialCard to a patient in an activated form.
When
the doctors issue the cards they are activated by a special card
reader, and are subsequently deactivated by a pharmacy dispensing
system.
When issued, the cards carry the name of the drug company, the
name of the drug, and the quantity of drug available to the patient.
Privacy is preserved in that the patient name does not appear
on the card physically or digitally at any stage, and the card
become inactive after dispensing.
Some demographic information is recorded, however, which helps
drug companies fine tune their marketing, and which theoreticlly
reduces marketing costs and eventually, the cost of the drug.
There would be little difference in the cost of producing sample
packs, compared to actual dispensing packs. In fact it is possibly
more expensive, due to the limited manufacture runs for samples,
and the loss of manufacturing capacity for other drugs as they
are being processed.
Some of the TrialCards may be allowed to be reactivated under
certain conditions.
An
overview of the process is:
1.
TrialCards are distributed to a doctor.
2. A TrialCard is activated by the doctor for a patient, by swiping
it through a card reader.
The card takes on the value of what is already preprinted on the
front of the card e.g. Nexium 40 mg 30 tablets, or any other drug
by any other manufacturer, depending on what has been impregnated
by the Trialcard controllers.
3. Pharmacist dispenses against the trialcard, which is then inactivated
through their dispense system.
4. Pharmacists redeem the value of the product, dispensing fee
and counselling service, by transmitting the card details electronically
to the manufacturer.
Patients
can receive up to 30 days treatment on each activation, and some
manufacturers allow up to three or four activations before the
patient has to pay privately or pay the imposts under the Pharmaceutical
Benefits Scheme (PBS).
The advantages to the drug company are that they are better able
to measure the effectiveness of their detailing to doctors, and
they can assist in patient compliance, especially for those patients
of limited financial means.
Drug
manufacturers have become so keen on the card that they transform
them into debit cards after the initial sampling period.
Patients are able to redeem future repeats of their drug using
a $10 credit lodged by the manufacturer on the patient's original
TrialCard.
The system has so many permutations and combinations, it is not
too difficult to see that alliances could be forged with Health
Funds or government agencies, in a manner to prolong the life
of the debit card.
This could represent a cost effective claims process or better
use of a government subsidy, and is worthy of government planners
looking at whether this type of system could be incorporated in
the Better Medication Management System (BMMS).
All
the participants in the scheme seem to be well satisfied by pharmacist
involvement, in that they know the medication has been stored
properly, they know that the patient will be counselled professionally
and will be told about drug interactions and side effects.
They also know that documentation is being done correctly under
the various laws, including a patient specific label, coupled
with the fact that a full medication review can be ordered by
the doctor, if there is further concern.
Only
one negative has appeared on the horizon so far, and that is America
being America, patients are allowed to ring a freecall number
and get a TrialCard (inactivated) direct. This opens up an area
of patient pressure on doctors that I would not like to see happen
in Australia.
In
some instances, presumably where the drugs are not controlled
by statute, patients can ring direct to TrialCard and receive
an activated card.
This may not present a problem in the long term if the product
is unrestricted, but it may allow a channel to develop into non
pharmacy environments, should they be licenced for the system.
Professional checks could not be undertaken in those circumstances.
I guess this is no different to what is happening now in supermarkets,
but it does allow a manufacturer to direct these sales through
the means already noted above, to manipulate market share.
The system must result in an eventual larger volume of drug being
consumed, but I am still cognisant of the recent paracetamol death,
for even though the circumstances surrounding this death were
different to the setting described above, the principles remain
the same.
As
the scheme lends itself to virtually any product e.g foods, toiletries
etc, it is sure to take on a life of its own, and become a valued
marketing resource for any business at any level of the marketing
chain.
In an extract from a press release, a spokesman for the company
stated:
"The
15-employee company just "came out" officially, at a
pharmaceutical industry conference in Boston in late April, 2002.
It already claims the top 12 companies in the pharmaceutical industry
as clients.
It is about three months from moving out of its 4,000 square foot
offices into new 10,000 square foot offices.
The company generally hires project managers for each client and
brings them on as it brings on clients. They started selling in
August 2001 and landed the first major contract in September 2001.
The overall drug sample industry amounts to a whopping $US8 billion
a year.
The new method for delivering drug samples to doctors and patients
offers attractive benefits to nearly all concerned in the transactions,
"It's a win, win, win, win situation".
In
my next article I will explore the possibility of value-adding
to the above process by delivering drug information to doctors,
and becoming part of the detailing process. Meanwhile, please
review my previous articles to give a framework for pharmacy practice,
at
this link.
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