Invisible Prescribers: What You Do and Don't Know About NPs and PAs

How many prescriptions are written each year by nurse practitioners and physician assistants? It could be 200 million. Not that anyone is counting.
Mar 01, 2006

Current Prescribing Patterns
Before a pharmaceutical company dispatches a sales rep to a medical practice, the marketing department learns some basic facts about the physician: how many new prescriptions she's written, how many refills, and how much upside prescribing growth she might generate. What the rep usually doesn't know: who else—nurse practitioners and physician assistants—prescribes medications in the office, at a nearby clinic, or sometimes in a separate practice just down the hall. The rep could make another sales call, but for a variety of reasons he usually does not. Physician assistants and nurse practitioners remain poorly recognized, and therefore rarely courted by pharma. One barrier to marketing to these clinicians is simple lack of prescribing data. Information offered for sale by the big data providers frequently excludes nurse practitioners and physician assistants. And in the pharmaceutical industry, where there is no data, there is no marketing.

Pharmaceutical companies not only fail to market to this sector, they neglect to invite nurse practitioners and physician assistants to meetings or to include them in plans for continuing medical education. Most practitioners must complete 100 hours of continuing education every two years. By not counting nurse practitioners and physician assistants among valued prescribers, pharma misses the opportunity to shape the practice of these professionals.

Patient Care
Even when pharmaceutical companies set out to target this market, they are often uncertain how to address nurse practitioners and physician assistants. Their practices vary dramatically in scope and orientation, which makes it difficult for sales reps to develop consistent messages.

And in many cases, pharma's own rules get in the way of the sales force.

Continuing Medical Education
Reps are often charged with adhering to rigorous call schedules—many aim to see eight or 10 physicians a day—which leaves them little time to interact with nurse practitioners and physician assistants. And at many companies, rules dictate that reps do not receive "credit" for a sales call if they spend time detailing nurse practitioners and physician assistants.

In fact, pharma marketing policies regarding these medical professionals are often stricter than state laws. Manufacturers frequently restrict reps from sampling anyone but doctors, even though laws in all 50 states and US commonwealths set conditions under which nurse practitioners and physician assistants can accept, sign for, and dispense medication samples. So manufacturers' own physician-only signature policies hamper reps' ability to develop relationships with other clinicians.

How often do NPs meet with pharmaceutical reps weekly?
Whatever the difficulties, pharma is missing a good-sized market. More than 100,000 nurse practitioners and nearly 60,000 physician assistants currently practice. Just 40 years ago, nurse practitioners and physician assistants were rarely found anywhere but rural settings, which were severely underserved by physicians, and in the military, as medics.

Today, both disciplines have growing membership associations with outstanding national and regional leadership. Physician-assistant and nurse-practitioner associations lobby Congress and work closely with state boards of medicine to advance their causes. They have accredited training schools—collegiate and postgraduate—with rigorous admissions and graduation requirements.

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