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Costly dose of TV drug ads

`Why on earth' tout $10,000-$20,000-a-year specialized medications?

By Bruce Japsen
Tribune staff reporter

April 11, 2004

A wave of new television advertisements for some of the nation's most expensive drugs has insurers and economists bracing for their effect on health-care costs.

In particular, the ads could affect Medicare, which will begin covering some of these expensive treatments over the next two years as a broader prescription benefit for the elderly is rolled out.

The companies are ramping up advertising for treatments for anemia, cancer and rheumatoid arthritis that can cost several hundred dollars for one injection or more than $10,000 for a year.

Critics say there is little reason to advertise such treatments on TV because they come under a doctor's area of expertise. Specialists know what the latest treatments are, critics of the ads say.

"Why on earth would you have to do direct-to-consumer advertising on a drug that costs between $10,000 or $20,000 a year?" asked Dr. Allan Korn, chief medical officer of the Chicago-based Blue Cross and Blue Shield Association, a trade group representing some of the nation's largest health plans.

"If a consumer could self-treat, they want certain information about options but they are not going to be self-treating with these really expensive drugs," Korn said. "For non-discretionary kinds of things, these ads make no sense."

But drugmakers say TV ads for specialized treatments encourage patients who might not be on medication to see their doctor. The medicines also can prevent more expensive hospitalizations or surgeries, drugmakers say.

Johnson & Johnson, known for its consumer marketing prowess, blazed a trail in 1998 with its TV ads for Procrit, an anemia drug that can cost about $10,000 a year.

In the last year, its new ads have touted Procrit as an energy boost for cancer patients who are asked to see their doctors if they are feeling fatigued. The drug helps produce red blood cells.

For the campaign, J&J last year increased TV ad spending on Procrit by nearly 10 percent, to $56 million, from 2002 levels, according to TNS Media Intelligence/CMR of New York.

Chemotherapy fatigue

"We have data that show 70 percent of chemotherapy patients suffer from chemotherapy-related anemia and all of the fatigue associated with that," said J&J spokesman John Kouten.

But health plans say the ads pressure doctors to prescribe something that may not be necessary. And there are other fatigue treatments.

"To say you need to take this drug because you are feeling tired or run-down isn't right," said Korn, an oncologist. "Chemo makes you feel tired or run-down no matter what your hemoglobin level is."

Now J&J and two rivals have taken to TV to promote new rheumatoid arthritis drugs, which each cost at least $13,000 a year.

Last month, North Chicago-based Abbott Laboratories began TV spots for Humira on the heels of Amgen Inc.'s campaign that started last year for Enbrel. J&J said it began advertising on TV for Remicade in 2000.

"Patients are looking for information about their disease and looking for resources and new treatments that potentially could be better than what they are receiving," said Amgen spokeswoman Andrea Rothschild.

Abbott and other makers say only a small percentage of the nation's 2 million rheumatoid arthritis sufferers are taking these new treatments.

Unlike other treatments that simply alleviate pain and suffering of rheumatoid arthritis, Humira, Remicade and Enbrel also have been shown to slow progression of the debilitating disease that could leave many patients in wheelchairs.

"Only half of [rheumatoid arthritis sufferers] are treated," said Tim Walbert, vice president and general manager of Abbott's immunology group.

For Abbott, TV marketing of Humira is in addition to traditional practices that relied primarily on sales representatives. Abbott deploys 100 to 200 Humira reps to reach the nation's nearly 4,000 rheumatologists.

Analysts are puzzled at the new strategies given that so few physicians prescribe rheumatoid arthritis treatments as opposed to the more than 200,000 primary-care doctors who prescribe routine maintenance medications.

"Typically, when you market to rheumatologists, you show up to their offices," said Paul Ginsburg, an economist and president of the Center for Studying Health System Change in Washington. "Isn't this now amazing that they can advertise and use a mass media approach to reach a narrow slice of consumers? A more efficient marketing approach would be to go to the rheumatologist."

Abbott said the ads are necessary, in part because primary-care physicians are known to misdiagnose rheumatoid arthritis, sometimes mistaking its early symptoms for the much less debilitating osteoarthritis, a disease of the joints affecting more than 20 million Americans.

Patients not diagnosed

"You have 50 percent of RA patients who are undiagnosed by primary-care physicians," Walbert said. "A primary-care physician sees an RA patient once out of over 100 patients."

Abbott has placed the new ads mostly on cable networks such as Lifetime whose audiences, women age 35 to 50, would be more likely to suffer from rheumatoid arthritis.

Abbott's strategy is almost sure to pay off, if you ask health plans who have watched their tabs for prescriptions rise.

Spending on direct-to-consumer advertising, which includes mostly TV, will triple this year from 1997, to more than $3 billion.

The state's largest health insurer, Blue Cross and Blue Shield of Illinois, says its biggest pharmaceutical expenditures are typically from routine maintenance drugs advertised on TV.

But the expensive biotech treatments are gaining ground. Amgen's Enbrel rose to No. 11 in the Illinois Blue Cross and Blue Shield ranking of prescription spending last year, when Amgen began advertising the brand on TV.

"One year earlier, Enbrel was not in our top 20 drugs," said Illinois Blue Cross spokesman Tony Rau.

Insurers noticed an increased demand for prescription drugs in early 1998, within months after the Food and Drug Administration's August 1997 decision to loosen restraints on radio and TV advertisements for prescription drugs.

Those early ads were for routine maintenance drugs to treat allergies, heartburn and high cholesterol, medicines such as Prevacid for heartburn, Zoloft for depression or Lipitor for high cholesterol that cost a few dollars a pill.

As TV ad spending increased, prescription spending, which had risen about 11 percent annually in the mid-1990s, rose to 18.4 percent in 1999. It has hovered in the mid-to-high teens since, according to most industry estimates.

The success of campaigns such as that for Enbrel is expected to foster more TV advertising of prescription drugs because the treatments are covered by most employers and insurers, analysts say.

Drug companies will have an even larger incentive as Medicare introduces more prescription drug coverage by 2006.

Neither Abbott's Humira nor Amgen's Enbrel are normally covered because they are self-administered, but they will have some coverage under new Medicare rules being implemented.

Currently, Medicare pays for a limited number of drugs that are administered in a doctor's office, such as Remicade and Procrit as well as dozens of cancer drugs.

Copyright © 2004, Chicago Tribune