Manufacturers devote considerable effort to marketing psychotherapeutics to physicians, although tactics vary. For example, both Janssen and Eli Lilly maintain a specialized detail force for mental health, whereas SmithKline Beecham promotes paroxetine largely through a non-specialty force. AstraZeneca promotes quetiapine through a generalized sales force dedicated to central nervous system products.14
The experience of a company in marketing through certain channels may affect the success of a particular drug. Eli Lilly and Janssen are recognized as experts in mental health marketing. The synergy of fluoxetine and olanzapine doubtless provide Lilly with a certain advantage in promotion. On the other hand, the relative inexperience of AstraZeneca in the mental health market may account in part for the slow diffusion of quetiapine in the treatment of schizophrenia.
It is generally assumed that manufacturer contracts and rebates may affect drug utilization. However, no data exists to support this idea, largely because such data are considered trade secrets. Indeed, none of the manufacturers or health care payers interviewed would discuss any such arrangements. For example, Medi-Cal requires manufacturers to enter into supplemental rebate arrangements with the State prior to including a drug on the formulary, although the exclusion of a drug from the formulary does not necessarily represent the failure of the manufacturer to offer Medi-Cal an acceptable rebate. However, Medi-Cal would not disclose the terms of any such arrangements. Our research does not support the assertion that rebate arrangements are more or less common for physical health medications than they are for psychotherapeutics. Although several MCOs and PBMs participate in volume-based or market share-based rebates or contracts for psychotherapeutics, the significant price differential between the branded and generic therapies prevents contracts or rebates from demonstrating considerable cost-effectiveness to providers.
To increase consumer demand and awareness for particular drugs, manufacturers often use direct-to-consumer advertising. There is a strong belief among consumer and provider associations that direct-to-consumer (DTC) marketing affects drug utilization. However, there are currently no data to support this. This issue may represent another area where follow up research may be useful.
The NMHA believes that direct-to-consumer advertising disseminates valuable information to patients that they may not otherwise receive. However, other respondents feel that marketing efforts may be merely a form of physician or consumer "brainwashing." That is to say, physicians are convinced to prescribe drugs manufactured by the company whose representative visits most frequently, even as consumers grow to demand the drugs with the most appealing promotional materials. The APA reported that DTC marketing probably increases drug utilization, but has not collected data to support this.
Several manufacturers maintain websites that describe their drugs or the diseases they are intended to treat. Sites generally have areas for consumers and for providers. Manufacturers believe these methods of promotion to be effective, but did not provide data on their direct effect on product sales. Sites are often named for the drug on which they provide information. Examples include citalopram (www.Celexa.com), fluoxetine (www.Prozac.com), paroxetine (www.Paxil.com), olanzapine (www.Zyprexa.com), and quetiapine (www.Seroquel.com). Solvay maintains a comprehensive site of information on the treatment of obsessive compulsive disorder (www.ocdresource.com). The paroxetine site now focuses heavily on the use of paroxetine in the treatment of social anxiety disorder, the newest indication for paroxetine. The launch of paroxetine for social anxiety disorder also represents one of the most visible uses of DTC in the mental health area.
Providers express some frustration at the potential for misinformation and the increase in consumer demand for particular products that may or may not be the best therapy for a patient who demands it.