Pharma Spends More On Ads Pushing Low-Value Drugs

A new study highlights the complex dynamic between consumer advertising for prescription drugs and patients and clinicians.

The pharmaceutical industry spends more money on advertising for drugs with lower health benefits, a new study shows.

Researchers at the Johns Hopkins Bloomberg School of Public Health found that the share of promotional spending allocated to advertising averaged 14.3 percentage points higher for drugs with low added benefit compared to drugs with high added benefit.

The analysis, to be published online in JAMA on February 7, also revealed that 92 of the 135 drugs (68%) examined by the researchers—of the top-selling prescription drugs sold in 2020— were rated as offering low added benefit.

Because the U.S. does not rate prescription drugs for comparative effectiveness, the researchers used France and Canada's ratings of the same prescription drugs sold in the U.S., some under different brand names. 

The researchers say their findings highlight the complex dynamic between consumer advertising for prescription drugs and patients and clinicians.

"The findings suggest that shifting promotional dollars to direct-to-consumer advertising potentially reflects a strategy to drive patient demand for drugs that clinicians would be less likely to prescribe," says study lead author Michael DiStefano, PhD, an assistant scientist in Bloomberg's Department of Health Policy and Management.

The U.S. and New Zealand are the only countries that allow direct-to-consumer advertising for prescription drugs. 

The median promotional spending per drug in the study sample, including to patients and clinicians, was $20.9 million in 2020. The median spending per drug on direct-to-consumer advertising was 13.5% of promotional budgets.

Since 1996, annual direct-to-consumer advertising budgets for prescription drugs have increased from $1.3 billion to, in 2016, $6 billion. 

Earlier research suggests that direct-to-consumer advertising increases patient requests for advertised drugs and increases chances that clinicians will comply.

While patient requests for advertised drugs may present a chance to discuss treatment options, the researchers say this may also lead to tension if the patient requests are refused. 

"When a consumer sees these advertisements on TV or social media, they should really question if it's the best drug for them and have a conversation with their provider," DiStefano says.

The study drew from IQVIA databases that report national sales estimates and promotional spending for pharmaceutical drugs. The analysis focused on 134 of the 150 top-selling branded prescription drugs in 2020. These 150 drugs represented 60% of all U.S. drug sales in 2020. Sixteen drugs were excluded from the primary analysis due to missing data. The percent of total promotional spending allocated to DTCA for each product was computed.

France uses five possible ratings for added benefit—major, important, moderate, minor, and none. Canada uses four categories—breakthrough, substantial, moderate, slight/none.

The ratings are based on clinical research. For their rating categories, the researchers aggregated the top three ratings into "high added benefit" and the remaining ratings into "low added benefit" from France and Canada's ratings. Both countries use their ratings to inform pricing, DiStephano says.

The analysis, funded by Arnold Ventures and the Agency for Healthcare Research and Quality, used France's ratings for 108 drugs and, when there were no French ratings, Canada's ratings for 26 drugs. 

The researchers also found a large variation of spending on direct-to-consumer advertising among the prescription drugs analyzed in the study. Manufacturers of six of the best-selling drugs spent more than 90% of their promotional budget targeting consumers versus clinicians.

These drugs include treatment options for motor neuropathy, various cancers, including breast cancers, multiple sclerosis, and HIV. Drugs treating metabolism and the digestive tract had a significantly lower share of total promotional spending on direct-to-consumer advertising. 

The authors concede that they looked at only one year, that their data did not capture all promotions, such as patient coupons, and that France's and Canada's ratings may reflect different value judgements.

"This comes down to a consumer issue, not necessarily a policy issue," says Gerard Anderson, PhD, professor in the Department of Health Policy and Management and senior author of the study.

"Another consideration is the U.S. doesn't currently rate prescription drugs," Anderson says. "Imagine if the drug ads you saw on TV were required to tell you how well the drug performed against alternative drugs for the same disease. That might change how interested you would be in the drug."