Decoding The NHS

A Trust comprising of 3 hospitals were under considerable ‘bombardment’ from COX2 companies pushing considerable data and marketing materials. One company managed to involve pharmacy in the review. The rest tried but for a number reasons did not gain access. Furthermore, this company managed to get a lead rheumatologist to apply for the drug to the D&T. Significant letters were also written from a pain consultant, a consultant in general medicine, a pain consultant and a care of the elderly consultant. All requested this same COX2 agent for formulary acceptance! This had never happened before…

At the D&T meeting the rheumatologist put forward the COX2 for application. The feedback from the directorate pharmacists revealed that the consultants who had also supported this drug were in fact using it off-formulary and prescribing the agent in outpatients.

A debacle followed.
The drug was thrown out. The consultant was furious. Pharmacy was displeased with the outpatient prescribing. The rep had reportedly told the consultants that pharmacy was supporting the drug. The pharmacy was told that the consultant was keen on their COX2. The whole thing was a mess!!!

The consultant in question wanted the drug for himself or for none at all. That is the case within the trust in question (unnamed) to this day. COX2 are banned. None on the formulary and there has been a broad sweep to abandon them for some while.

The consultant was quite indignant that other doctors were dabbling within ‘his’ specialised area…There was no drug to be evaluated.

Analysis
Remember all pharmacists maintain contact with each other. We may not always know of some practice directly, but a little probing will often lead us to the right answer

Don’t Don’t Don’t tell pharmacists that a ‘consultant wants to use your drug’. Why? Because of 3 things

  1. So what – just because a consultant wants to use it in itself means nothing. An intention to bring to D&T is another.
  2. What if the consultant is lying to you? They tell reps things for a number of reasons. Sometimes to get rid of them!! Analysis
  3. Has it occurred to you that some consultants tell all their reps ‘yes I like your drug’
  • Care if you have loads and loads of fans at the D&T. Especially if you have one champion. Care for upsetting people
  • Have you seen the directorate pharmacist for your area – they supply true therapeutic intent of consultants. See them as they will tell you how likely you may be received by people like me and people like consultants
  • If your drug is in paediatrics and you haven’t seen the paediatric pharmacist, you may get on formulary but you will have lots of difficulties after that
  • If your drug is in medicine and you haven’t seen the medical pharmacist you probably will have difficulty before you get going
  • Don’t tell all your customers that everyone wants to use your drug. If you want support be very precise and specific…. Who wants to support your drug and in which patients and how often. Don’t just say – Mr X wants our drug – you had better put it on the formulary!!
  • See the drug information pharmacist – they supply much info to the D&T committee
  • If your drug fails – start again. Though wait a while. Presume pharmacy have thrown away all your documents. They tend to stack up before a review, then only keep the successful drugs
  • Remember that pharmacist speak to each other and consultants as well. The medics often tell us ‘the real deal’ and will often spin you a story to get something (a meal, a trip, etc)
  • Do regular pharmacy lunches as this familiarises us with your product
  • If your drug is not on formulary are pharmacy swapping? For example, are they substituting your agent for another that is on formulary (i.e.) PPI, statins, CCBs
  • Find out how many D&Ts your formulary pharmacist sits on… remember whilst you may have difficulty tracking down D&T members, the FORMULARY PHARMACIST & DIRECTOR of PHARMACY are the two people that will definitely be on the D&T

This was a classic case of politics and maybe too aggressive repping having ruined not just one but probably future D&T applications.