Dealing in Diabetes: Inside the Pharmaceutical Industry, From a Patient’s Perspective

If you’re like most folks in America, you have a pretty specific view of pharmaceutical sales reps- they’re right up there with used car salesmen and fortune tellers. (Read: can’t trust ‘em.) Most people believe that pharma sales reps are Barbies in business suits who use fancy dinners and vacations to bribe doctors into using their expensive, brand-name medications.  Years ago, that might have been the story. But today things are different, and as a person who has type 1 diabetes and works as a pharmaceutical sales rep, I know for a fact that reps can bring value to healthcare professionals in a unique role that ultimately serves the patient.

I’ve had diabetes for 17 years, and it was always important to me that I work in the diabetes space somehow. After a few years post-college trying to figure out a career by process of elimination, I realized that the pharmaceutical industry would give me an opportunity to work with diabetes every day while still building a solid career for myself.

I came in to a pharmaceutical company as an entry level coordinator, and after four years have moved into the sales force for my organization. My company makes only diabetes drugs, so my new day-to-day became all diabetes, all the time. And as quickly as day one, I realized I would have to help change the perception of pharmaceutical reps if I were truly going to change the lives of patients though my work.

Let’s get a few things straight here, because there are so many misconceptions about pharmaceutical sales reps that it’s no wonder we have a poor reputation. To start, doctors do not get paid to prescribe certain drugs. Doctors can prescribe whatever they want –they may be incentivized to prescribe certain medications over others because of their formulary committees and managed care plans (e.g. who they work for), but not from the pharmaceutical company. Companies do pay their reps commission for the number of prescriptions they garner, but the doctors are not part of that deal. Second, it’s worth noting that major regulatory modifications over the past ten years have completely changed the game of pharmaceutical sales. For example, reps cannot take a doctor out to a restaurant unless there is an educational program with a speaker and slide presentation accompanying it. And all companies now have limits on the amount they can spend per person at those “moderate” FDA-approved dinners.  Companies can also no longer give out pens, Kleenex, or other branded materials to doctors’ offices. So when a rep walks in the door, she can leave behind only FDA-approved educational materials for the healthcare providers that include a fair-balanced message about their drug. (Fair-balanced means we have to discuss side effects and downsides along with benefits.)  Long gone are the days of lavish vacations disguised as “seminars” or reps detailing a doctor on the driving range. I support these regulatory changes because it levels the playing field. Each rep now has to rely on the science and merit of her medications to bring value to a customer, not the size of her marketing budget.

So you might be wondering why, without all these fancy marketing materials, are pharma reps in doctors’ offices at all. One important aspect of being a pharma rep is bringing drug samples to an office. Has your doctor ever given you a free sample of a new drug to try? Or perhaps your insurance had run out and your practitioner floated you for a couple of months on samples? There were many times in college where samples tided me over until my next paycheck went through. Samples are highly regulated by the government. A rep cannot leave drug samples for the doctor to distribute to patients without a signature from the doctor, and most companies require that the rep witness the signature to prevent falsification or diversion. For that reason alone, it’s important that reps get face time with the physician.

Another reason for reps in doctors’ offices is information. Hold on, you might be asking – didn’t my doctor go to medical school? Doesn’t he already know about the drugs out there? And if it’s new, didn’t he read about it in a medical journal somewhere?

Sometimes is the answer. There are many classes of drugs that have been around for ages that most practitioners will be well schooled in.  Some newer medications, however, might not be as well understood. Or perhaps the practitioner has heard of it, but isn’t sure who the appropriate patient is. Sometimes medications have complicated delivery methods, and the doctor needs to learn how to start a patient on it. And sometimes, a physician is just too busy seeing patients to have a second to read up on the latest and greatest. This is where a good pharma rep can come in handy.

Pharmaceutical reps have the ability to become subject matter experts in a particular drug class. We know which patients will succeed on our medications, how to get it covered by insurance, and what the risks are. Within thirty seconds we might be able to give a physician an option that he or she might not have thought of, or realized was available. And at the end of that information stream is a patient who could benefit.

The pharmaceutical industry has gained a poor reputation for good reason. There were years of reps abusing their time and role with physicians. And there must be accountability on the part of the physicians as well – before the laws changed, there were indeed doctors guilty of over-prescribing in exchange for the expensive meals and all-expenses paid retreats. And certainly, even with all the regulatory changes, there are still corrupt individuals within this profession.  But a good rep – a person who cares about the patient, about bringing value to an office every day – can be a tremendous asset to the medical world and responsible for changing patients’ lives.

As a person with diabetes, I already know what it’s like to have to deal with a full-time job that you didn’t ask for. Diabetes is 24/7. It’s expensive medications, hours on the phone with insurance companies, and the constant fear of complications down the road.  I also know how important time with our healthcare practitioners is, and therefore I am the last person who wants to waste the time a doctor could be spending with patients.  But I also want patients to have the opportunity to know what’s available to them, to know what the options are and what tools they can have in their kits to manage this disease.

The fact that I have diabetes and take the medication my company makes is an asset in my professional role. I understand who the appropriate patients are for the drug, I know what barriers the patients face, and I can share my anecdotes with doctors and answer their questions from a real-world perspective. Because I live with diabetes every day, I know how hard it can be to try to do everything right for this disease and still feel like a failure some days. And I know that I bring this important information to my customers with my personal story – pearls that may help them reach a patient who seemed unreachable. And not every rep has to have the disease for the drug class they work in – pharma companies spend thousands of dollars on rep training to ensure reps are experts on both their product and the condition it treats. My non-diabetic counterparts have attended classes at institutions like the Mayo Clinic to learn what it’s like to live with diabetes.

Although this is a career where having diabetes can be an advantage (for once), this dual role as both a patient and a rep is a difficult one. I am evaluated on my ability to move numbers as a sales person, but I am a patient advocate first. Knowing how difficult diabetes management can be means I am in no position to tell anyone what they should do for their care. Which is why I don’t. I tell people what they could do for their care. I let them know each and every resource available to them, and I help continue the education of their practitioners so that no patient is left without options.

In a perfect world, all pharmaceutical companies would gather their wares on a proverbial Main Street, where passersby could see all of the options available, with guidance from their doctors. The communal foot traffic of the drug marketplace would allow business for all, with each patient matched to the perfect care for their needs.

The reality, however, is that we live in a world where bottom lines can drive motivation, and I am the first to say that pharmaceutical companies must continue to improve the value they place on the patient.

For those of you who think that pharma reps are around only to distract your doctor with glossy marketing materials, please know that there are thousands of us out here who are patients just like you, who want to make sure that everyone has powerful and life-changing medications available to them, and the resources to ensure they are successful with those medications. I say that with confidence because every day, I have to get up and live with diabetes, just like the patients I see in my customers’ offices. We just might be on the same side, after all.

Alexis Pollak

Alexis Pollak, author of the blog I Run on Insulin was diagnosed with type 1 diabetes seventeen years ago, at the age of ten. Diabetes advocacy and supporting people with diabetes is her passion, and she is volunteer chair of the San Diego Tour de Cure.

Alexis Pollak

Alexis Pollak, author of the blog I Run on Insulin was diagnosed with type 1 diabetes seventeen years ago, at the age of ten. Diabetes advocacy and supporting people with diabetes is her passion, and she is volunteer chair of the San Diego Tour de Cure.