January 2020
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Drug Policy 101: Pharmaceutical Marketing Tactics
Institute for Health Policy
This brief describes the types of marketing tactics that pharmaceutical companies use
and the adverse impacts those tactics can have on patients, clinicians, and the health
care system.
Pharmaceutical marketing aims to shape both patient and clinician perceptions about a drug’s benet.
However, prescription drugs are not typical consumer products. Patients rely heavily on conversations
with and advice from clinicians to make decisions, including when faced with choices about whether and
which drugs are appropriate treatment options. In addition, patients often do not know the true cost of
a prescription drug as it is often subsidized by insurance. Likewise, clinicians may be unaware of and not
nancially affected by the drug’s underlying cost. Therefore, they might not take into account considerable
disparities in price between different, but comparably effective, options for patients. As a result, both
patients and clinicians are often insulated from the direct nancial impact of selecting a higher-priced
product. Due to these dynamics, pharmaceutical marketing can signicantly impact patient and clinician
decisions that then greatly affect outcomes, in
addition to draining government and health care
system resources.
Marketing tactics can drive overprescribing
through higher doses and longer courses of
treatment than are necessary, as well as overuse
of newer, higher-priced drugs instead of existing,
lower-cost therapies that are just as effective.
There has been an uptick in pharmaceutical
marketing, which is concerning. In 2016,
pharmaceutical companies spent $20.3 billion
— up from $15.6 billion in 1997 — marketing to
health care professionals and $6 billion — up
from $1.3 billion in 1997 — marketing directly
to consumers.
1
In fact, 9 of the 10 largest
pharmaceutical companies spent more on sales,
overhead, and marketing their products than on
research in 2013.
2
Marketing to patients
Direct-to-consumer advertising
One common way pharmaceutical companies promote their products to patients is direct-to-consumer
(known as DTC) advertising through television commercials, online ads, print magazines, and social media.
The United States is one of only 2 countries that allows DTC broadcast advertising for pharmaceuticals.
Since the Food and Drug Administration relaxed requirements for pharmaceutical broadcast advertisements
in 1997, consumer drug advertising spending has grown substantially.
3
In 2016, the pharmaceutical industry
spent $6 billion on 4.6 million DTC ads, including 663,000 television commercials.
4
20161997
$20.3B
$15.6B
Marketing to
health care professionals
Pharmaceutical companies spend billions
on marketing
20161997
$6B
$1.3B
Marketing to
consumers
January 2020
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DTC advertisements create an array of public health and scal concerns, including over-prescribing;
increased demand for clinically inappropriate, expensive versions of medications; and higher drug
spending that may not produce better health outcomes.
Consumers exposed to drug advertisements often ask
clinicians to obtain an advertised product.
5
For example, one
survey found that 1 in 8 adults were prescribed a specic
drug after seeing it in an advertisement and asking their
physician about it.
6
The Government Accountability Ofce
found that between 18% and 44% of consumers who had
seen DTC advertising reported discussing the condition or
drug advertised with their physician. Of those who spoke
with their physician, about one-quarter reported requesting a
prescription for the drug advertised and generally more than
half of those patients received the requested prescription.
7
Often, drugs featured in these advertisements are more
expensive versions of other brand or generic alternatives that
are just as effective and less costly to the patient. For example,
pharmaceutical companies have spent hundreds of millions
of dollars a year promoting newer and more expensive blood
thinners on television, even though less-advertised alternatives
are much less expensive, often just as effective, and may carry
fewer risks for patients.
8
Discount cards and coupons
Pharmaceutical companies market to patients using discount cards and coupons to incentivize uptake for
higher-priced drugs, thereby working around clinician and payer preferences for higher-value drugs. This
tactic, which can provide short-term out-of-pocket cost savings to patients, ultimately inates pricing and
increases use of higher-priced drugs, even when lower-priced therapeutically equivalent drugs — including
generics and biosimilars — are available. According to some estimates, almost half of all drugs that are
eligible for coupons and discount cards have a lower-cost generic competitor.
9
Another study found that
coupons and discount cards increase prescriptions lled with brand-name formulations by more than
60%.
10
Discount cards and coupons also provide pharmaceutical companies with patient-specic contact
information that can be used to encourage patients to stick with branded drugs even as lower-priced
generics or other competitor drugs enter the market.
Coupons and discount cards are protable marketing strategies for pharmaceutical companies. One study
found that coupons for only 23 drugs increased domestic drug spending by between $700 million and $2.7
billion from 2007 to 2010.
11
By pushing patients toward higher-priced options, pharmaceutical companies
can also work around evidence-based treatment recommendations and formularies to increase drug spend
across the health care system. While coupons may reduce immediate costs to individual patients, they
contribute to rising health care costs through increased premiums for consumers overall.
Funding patient advocacy organizations
Patient advocacy groups are growing in inuence and can mobilize large numbers of people around a
particular disease, disability, or condition. While some of this growth is a natural consequence of the internet
enabling patients to locate and communicate with one another at low cost, pharmaceutical companies have
seized the opportunity to leverage patient voices in support of their business objectives. One project found
Drug Policy 101: Pharmaceutical Marketing Tactics
The Government Accountability
Ofce found that between
18% and 44% of
consumers who had seen DTC
advertising reported discussing
the condition or drug advertised
with their physician. Of those
who spoke with their physician,
about one-quarter
reported requesting a
prescription for
the drug advertised and
generally more than half of
those patients received the
requested prescription.
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Drug Policy 101: Pharmaceutical Marketing Tactics
that just 14 pharmaceutical companies gave at least $116 million to patient groups in a single year — more
than those same companies spent on lobbying activities. This spending raises concerns about the inuence
drug makers gain by accessing indirect, less regulated channels for marketing drugs.
Patient advocacy groups can reach vast numbers of highly targeted patients and their family members
through various forms of communication, making them invaluable audiences and spokespeople for
pharmaceutical companies wanting to shape perceptions of particular drugs. While companies must
disclose money spent on lobbying and payments to doctors, they are not required to disclose payments to
patient advocacy groups.
12
Financial ties to drug makers potentially create a conict of interest for patient advocacy groups, which may
affect their organizational positions and ultimately how patients view certain drugs.
13
Marketing to clinicians
Pharmaceutical detailing
Pharmaceutical detailing is marketing conducted by drug
manufacturers that directly targets clinicians and pharmacists.
Detailing is commonly conducted by sales representatives who
meet with clinicians to communicate the benets and uses of
their company’s drug products and plays a central role in the
promotion of pharmaceutical products. In 2016 alone, the
pharmaceutical industry spent $5.6 billion on sales visits to
clinicians.
14
Detailing can be useful and educational in some
contexts, but it is often intended to increase pharmaceutical
company revenue by maximizing drug sales or steering
clinicians toward higher-priced drugs that might not be the
best value for the patient. This makes it difcult for doctors to
nd the unbiased information they need to make
informed decisions.
Free samples
Another way pharmaceutical companies market to clinicians
is through distribution of free samples, which are drug or
biological products meant for patient use but not intended to
be sold. In 2016, the pharmaceutical industry gave out $13.5
billion in free samples.
16
Despite their wide distribution to clinicians — and
subsequently to patients — samples are exempt from reporting
requirements under the Physician Sunshine Act, which requires
manufacturers to report any payments or other transfers of
value made to licensed physicians or teaching hospitals. Distribution of free samples is very common;
therefore, excluding them from this reporting requirement creates an incomplete picture of how industry
marketing tactics are used to inuence prescribing.
17
In fact, researchers have demonstrated that clinicians
are more likely to prescribe medications given as samples even when that medication would not otherwise
be their rst choice.
18
Example: Purdue Pharma
Purdue Pharma — the
manufacturer of OxyContin —
focused its sales campaign on
in-person visits to clinicians
where sales representatives
allegedly encouraged
prescribing OxyContin for
longer courses and at higher
doses despite knowing the
serious risks of addiction and
even death. Purdue Pharma
marketing materials allegedly
misrepresented scientic
evidence to suggest to clinicians
that longer courses and higher
doses were benecial to certain
patients. Purdue Pharma’s
OxyContin marketing
practices are the subject of
ongoing litigation.
15
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Drug Policy 101: Pharmaceutical Marketing Tactics
Free samples may seem like a way to reduce costs for patients, but research shows they raise costs
for patients in the long term. More specically, patients who are given samples ultimately have higher
prescription costs than those who do not receive samples because patients will often remain on the higher-
priced drug they were initially sampled rather than switching to a lower-cost, potentially higher-value
alternative.
19
Free samples are often distributed for more expensive products, brand name drugs with
generic alternatives, and drugs with questionable effectiveness.
20
And additionally, though manufacturers
may argue that samples help patients facing nancial hardship access medications, the reality is low-income
or uninsured patients are far less likely to receive samples than wealthy or insured patients.
21
Free samples also present safety and quality concerns, as samples are not always stored properly, or they
expire, because pharmacists — who are typically responsible for overseeing those issues — are generally
bypassed in the distribution process.
Promotional materials and events
In addition to in-person meetings, pharmaceutical companies will often distribute unsolicited promotional
materials to clinicians, such as brochures, to highlight the benets of their drug and positively describe the
results of studies, which are often funded by the same company. Analysts have also documented examples
of industry-funded ghostwritten articles in medical literature that include marketing messages for a certain
product.
22
Despite the FDA’s efforts to regulate false and misleading communication about drugs, the
overwhelming amount of content and channels available to pharmaceutical companies makes enforcement
challenging. For these reasons, many promotional activities to clinicians fail to present a complete and
objective picture of a drug’s safety and effectiveness.
Manufacturers also fund informational events and presentations for medical professionals that promote
disease awareness. And while such events may not directly promote specic products, they might shape
perceptions of a disease, including its prevalence, severity, and appropriateness of pharmacological
intervention, thus increasing prescriptions down the road. In 2016, pharmaceutical companies spent almost
$59 million for disease awareness education.
23
Funding to clinicians and academic institutions
Pharmaceutical companies spent nearly $979 million for direct physician and teaching hospital payments
related to specic drugs in 2016, offering gifts, consulting
and speaker fees, meals, and other material items.
24
It is not
uncommon for companies to host promotional events and
invite industry-paid clinicians to discuss the use and benets
of particular drugs. Data over a recent 5-year period show
that drug and medical device companies paid more than
2,500 physicians at least half a million dollars each — and 700
physicians received at least $1 million.
25
Researchers have
evaluated the impact of these practices on prescribing patterns,
and studies have found that clinicians who received food, gifts,
or consulting fees were twice as likely to prescribe the brand
name drug instead of the lower-cost generic.
26
Pharmaceutical companies also attempt to inuence academic medical centers, universities and curricula,
and continuing education activities to sway clinicians downstream. Medical students are increasingly
exposed to pharmaceutical marketing, receiving such items as industry-sponsored meals, gifts, and
Studies have found that
clinicians who received food,
gifts, or consulting fees were
twice as likely to
prescribe the brand name
drug instead of the
lower-cost generic.
January 2020
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educational materials.
27
A systematic review of literature on this topic found that almost 90% of all clinical
students received some sort of educational materials from the pharmaceutical industry.
28
Continuing
medical education programs also receive industry funding.* Researchers found that 72% of CME activities
from the top 500 accredited CME providers in 2014 were sponsored by industry.
29
Industry-funded
clinicians, teaching hospitals, medical schools, and continuing education activities may contain promotional
messaging, thus raising concerns about potential conicts of interest.
30
A path forward
Pharmaceutical marketing can have a signicant impact on prescribing decisions, leading to real
consequences for patient health and rising drug costs.
Unbiased sources of information about pharmaceuticals should be more readily available to the medical
community to help counter potentially misleading or even harmful marketing efforts.
Furthermore, policymakers and the public would benet from more transparency in marketing tactics
to foster understanding about how these practices might be inappropriately inuencing prescribing,
increasing drug prices and spending, and impacting patient outcomes.
References
1. Lisa M. Schwartz, MD, MS, and Steven Woloshin, MD, MS, “Medical Marketing in the United States, 1997-2016,” JAMA, Jan 2019,
https://jamanetwork.com/journals/jama/fullarticle/2720029.
2. Ana Swanson, “Big pharmaceutical companies are spending far more on marketing than research,” The Washington Post, Feb 2015,
https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-
research/.
3. C. Lee Ventola, MS, “Direct-to-Consumer Pharmaceutical Advertising,” P&T, Oct 2011,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278148/#b3-ptj3610669.
4. See note 1
5. Sara J. Becker and Miriam M. Midoun, “Effects of Direct-to-Consumer Advertising on Patient Prescription Requests and Physician Prescribing: A
Systematic Review of Psychiatry-Relevant Studies,” Journal of Clinical Psychiatry, Oct 2017,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293137/.
6. Bianca DeJulio, et al, Kaiser Health Tracking Poll: October 2015, Kaiser Family Foundation,
https://www.kff.org/health-costs/poll-nding/kaiser-health-tracking-poll-october-2015/.
7. Government Accountability Ofce, Prescription drugs: Improvements needed in FDA’s oversight of direct-to-consumer advertising (Report No.
GAO-07-54), Washington, D.C., 2006.
8. Michelle Llamas, “Selling Side Effects: Big Pharma Marketing Machine,” Drug Watch, Aug 2019,
https://www.drugwatch.com/featured/big-pharma-marketing/.
9. Karen Van Nuys, PhD, et al, “A Perspective on Prescription Drug Copayment Coupons,” Leonard D. Schaeffer Center for Health Policy &
Economics, University of Southern California, Feb 2018,
http://healthpolicy.usc.edu/documents/2018.02_Prescription%20Copay%20Coupons%20White%20Paper_Final.pdf
10. Leemore M. Dafny, PhD, et al, “Undermining Value-Based Purchasing—Lessons from the Pharmaceutical Industry,” New England Journal of
Medicine, Nov 2016, https://www.nejm.org/doi/full/10.1056/NEJMp1607378.
11. See note 10
Drug Policy 101: Pharmaceutical Marketing Tactics
* The term “Industry” in this case refers to pharmaceutical, biologics and medical device manufacturers.
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Drug Policy 101: Pharmaceutical Marketing Tactics
12. Emily Kopp et al, “KHN launches ‘Pre$cription for Power,’ a groundbreaking database to expose Big Pharma’s ties to patient groups,” Kaiser
Health News, April 2018, https://khn.org/news/patient-advocacy-groups-take-in-millions-from-drugmakers-is-there-a-payback/
13. Persuading the Prescribers: Pharmaceutical Industry Marketing and its Inuence on Physicians and Patients, PEW, Nov 2013,
https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2013/11/11/persuading-the-prescribers-pharmaceutical-industry-marketing-
and-its-inuence-on-physicians-and-patients.
14. See note 1
15. Commonwealth of Massachusetts v Purdue Pharma, Richard Sackler et al, Superior Court Civil Action, Suffolk, June 2018,
https://www.mass.gov/les/documents/2018/06/12/Purdue%20Complaint%20FILED.pdf.
16. See note 1
17. Elizabeth Richardson, “The Physician Payment Sunshine Act,” Health Affairs, Oct 2014,
https://www.healthaffairs.org/do/10.1377/hpb20141002.272302/full/.
18. Tim Lahey, “The High Cost of “Free” Drug Samples,” Clinical and Translational Gastroenterology, Dec 2014,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274368/.
19. G Caleb Alexander, MD, MS, et al, “Characteristics of patients receiving pharmaceutical samples and association between sample receipt and
out-of-pocket prescription costs,” Medical Care, April 2008, https://www.ncbi.nlm.nih.gov/pubmed/18362819.
20. See note 1
21. Sarah L. Cutrona, MD, MPH, et al, “Characteristics of Recipients of Free Prescription Drug Samples: A Nationally Representative Analysis,”
American Journal of Public Health, Feb 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376889/.
22. Adriane Fugh-Berman, “The haunting of medical journals: How ghostwriting sold HRT,” PLoS Med, Sept 2010,
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000335.
23. See note 1
24. See note 1
25. Charles Ornstein et al, “We Found Over 700 Doctors Who Were Paid More Than a Million Dollars by Drug and Medical Device Companies,”
ProPublica, Oct 2019, https://www.propublica.org/article/we-found-over-700-doctors-who-were-paid-more-than-a-million-dollars-by-drug-and-
medical-device-companies.
26. Taeho Greg Rhee, PhD, MSW and Joseph S. Ross, MD, MHS, “Association Between Industry Payments to Physicians and Gabapentinoid
Prescribing,” JAMA, Jul 2019, https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2737748.
27. Jeffrey Kluger, “Is Drug Company Money Tainting Medical Education?” TIME, March 2009,
http://content.time.com/time/health/article/0,8599,1883449,00.html.
28. Aaron Kesselheim, “Does Pharmaceutical Industry Marketing to Medical Students Affect Their Prescribing Choices as Physicians,” Robert
Wood Johnson Foundation, https://www.rwjf.org/en/blog/2011/06/does-pharmaceutical-industry-marketing-to-medical-students-affect-their-
prescribing-choices-as-physicians.html.
29. Adriane Fugh-Berman and Alycia Hogenmiller, “CME stands for commercial medical education: and ACCME still won’t address the issue
(letter),” J Med Ethics, Dec 2015, http://jme.bmj.com/content/early/2015/12/16/medethics-2015-103131.full.pdf+html.
30. Margaret Infeld et al, “Continuing Medical Education and the Marketing of Fentanyl for Breakthrough Pain: Marketing Messages in an Industry-
Funded CME Module on Breakthrough Pain,” World Medical and Health Policy, March 2019,
https://onlinelibrary.wiley.com/doi/full/10.1002/wmh3.290.
