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How Pharma Can Cut Out the “Middleman” (aka “The Doctor”)



At some point along the way, I think I swore some oath that I’d use my knowledge for good and not for evil. And yet, I find myself writing posts about (among other things) How to Avoid FDA Regulations Using Mobile Marketing. Granted, I did mention in that post that “I’m not advocating intentionally avoiding FDA regulations,” but I suppose I gave a little help to those who might want to do such a thing (for the record, you rule breakers will love my post about What If There Were No Rules in Pharma Marketing?).

So today I’m here telling you how pharma can cut out the doctor all together. I’m not talking about DTC advertising, I’m talking about a world where pharma makes it unnecessary to go to a doctor’s office as part of the transaction of obtaining a prescription drug. Of course, today you need a doctor to write a prescription for many products. The patient then has to take it to his or her pharmacy to get the medication. That’s quite a hassle. Why not cut out having to go to the doctor? Sure, many Canadian “pharmacies” have made quite a living on this premise using their on-staff “physicians” to do a phone consultation with patients before writing a prescription; a prescription that I’m going to guess is only valid at the pharmacy they work at for many reasons. Naturally, I’m not recommending this approach.

I know that many of you are pretty upset at this idea right now, but bear with me for a moment. You’ll either be much more mad in a moment or intrigued.

Where did I come up with this hair-brained idea in the first place? As a routine, I try to stay on top of new developments in healthcare, especially new uses of digital technologies. A while back, someone called my attention to a company called American Well. I love the concept and what the company is about, but I never really thought of an angle for pharma marketing. Until now…

American Well

American Well’s simple tagline is: “The doctor will see you now.” That about says it all. What American Well does is provide a system that allows patients to talk via live chat, including video, with a physician any time of the day or night. Physicians are recruited by American Well and offered payment to be “on-call” during what might ordinarily  may be an off day. When you log into American Well’s system, you have some choices regarding which physician you’re matched up with. It’s not going to be your regular physician, but it’s going to be quality doctor who is willing to see you right now. They can’t do everything and they likely don’t have your full medical history, so think of it like a walk in clinic. Obviously, you can’t have them stitch up a cut or set a broken arm via the Internet, but for routine care, this is perfect. It could potentially save a trip to the emergency room for many and would be a godsend in the middle of the night for some tired parents.

American Well Interface

For a moment, think about the economics of this for a health insurance plan. Compare what they save on walk in clinic costs and emergency room visits opposite what they pay for American Well’s services. Since health insurance companies are pretty interested in these economic aspects of care, they’re on top of this. If you’re a member of Blue Cross/Blue Shield in either Hawaii or Minnesota, then you’re in luck. Access to American Well’s service is part of your standard coverage. How nice is that? For the rest of us, we’ll have to wait to use American Well. It’s got to be a no-brainer that many other plans will be offering this soon.

But I don’t want to wait and neither should you. However, I don’t have the resources to launch this service for me and all of my readers. Hmmm, I wonder who might though?

Ah yes, pharma companies. Picture this. You log onto, say, the Singulair product website looking for information about seasonal allergies and you’re trying to figure out if this drug is right for you.  After a little research, you decide that you’re going to ask your doctor about it. Now, your allergies are pretty bad, but they’re not killing you, so you try to set up an appointment with your doctor. Two weeks out is the soonest they have available for your non-emergency. Over the two weeks, do you forget about Singulair? Do you even keep your appointment (especially if your allergies got a little better or your schedule forced you to cancel a few times)? Well, if you forget about Singulair or don’t show up for your appointment, Merck is out of a new prescription.

On the other hand, if Merck had licensed American Well’s platform on the Singulair site, then you simply could have clicked a button and spoke with a doctor that second. The doctor would have examined you (as best as possible via webcam), did a thorough history, and asked a few other questions before deciding which allergy medication was right for you. Yes, this doctor won’t know everything about you and they couldn’t do a full hands on physical, but you’re not experiencing chest pains either. The patient, of course, could ask if Singulair is a good option. This physician isn’t a Merck employee and isn’t paid by Merck, so she could pick whatever she thought was appropriate…just like if you went to the office. Managing this kind of condition might be a perfect case where the American Well model works really well. Merck had to pay for the service, but will more than make a return with this new patient now starting treatment.

In the traditional sense, this would be going around the patient’s doctor, but it’s not cutting the doctor out of the equation like a sketchy Canadian “pharmacy.” A qualified, licensed physician made a diagnosis and prescribed a treatment just as he or she does in their “real world” practice. How much different is this than someone going to the Take Care Clinics at Walgreens or similar concepts in many other chains including Walmart? What about stand along “quick care” or walk in clinics? Not much as I see it. In the case of the clinic at Walgreens, you’ll be seeing a PA or NPA in person. In the online version you see an MD (or DO perhaps) via webcam.

Since the physicians on the other end of the service are ordinary doctors looking to supplement their income a bit, they still get the same promotional attention from pharma companies as any other physician in the country. You aren’t likely to find doctors who will only write prescriptions for the company that is sponsoring the use of the service. Even if you could, I doubt that American Well would stand for that and I doubt that any pharma company’s legal team would allow it either. So, what’s wrong with a pharma company providing patients live access to a physician 24/7? Isn’t this an incredibly valuable service to the community? We’re talking an awful lot about healthcare reform right now and about how some people can’t afford to go to the doctor. Well, here’s a pharma company bringing the doctor to you…for FREE.

Am I missing something? Is there any possible way to cast this in a negative light? Perhaps some doctors who aren’t interested in being a part of the American Well program will be a bit upset, as they might lose some patient visits and they’ll claim (probably correctly) that it isn’t the same level of care that they could provide. Fair enough, but is the upside worth the downside? As a pharma company, you can break it down by cold, hard math. Is the value of the increased prescriptions more than the cost of the American Well system plus the loss in prescriptions from doctors who hold a bit of a grudge against the company? Simple math really. Requires some estimation, but not many factors to consider.

So, is this a potentially an amazing example of Marketing with Meaning or a horrible idea that hurts patients and physicians (and “the system”)?

Just to be clear, before you leave angry comments, I’m not suggesting that pharma companies try to cut off the relationship between patients and their doctors. Nor am I suggesting that this be a replacement for an ongoing relationship with a physician who can manage your health over time. Having said that, there are going to be more technologies available that make it easy for people to get the products and services they want using the methods they want. Healthcare is no exception. So, while this might not be the answer or a feasible marketing tactic for pharma, did you know it even existed? If not, what else is out there that you should know about?

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  • This is a brilliant idea! I think sooner or later everybody will have access to a doctor via internet and it might be a game changer. Ofcourse it will not solve every case, but a lot more people will fill much more safer having a doc available 24/7.

    Great post.
  • Strongly disagree with the first "naive" comment. Docs working through American Well could be "on call" for a variety of sites. So while maybe he/she is on call for Merck Singulair, they are also on call for a dozen other pharma/product sites. Not as if their only income is going to come from one pharma brand.

    Also, to David Reim's point (or his wife's), certainly this doesn't work for all conditions. But there are a lot out there where it could.
    .-= Kevin at e-Patient Connections´s last blog ..2 good ways to get a discount ticket to e-patient connections 2009 =-.
  • Michael Golub
    I think the idea of incorporating American Well into a pharma brand site--while innovative-- would violate the concept of the "learned intermediary" by blending an rx product with the (traditionally completely separate) professional prescriber. And, as a result, the deep-pocketed pharma marketer would have to share responsibility for possible untoward outcomes (i.e. malpractice risk). Probably not something pharmaceutical industry lawyers would embrace.
  • Michael,

    Fair enough challenge, but what if the doctor didn't know which site he or she appeared on? They only knew that they were working with American Well and that they might be used on certain pharma brand sites from time to time. That eliminates some of the apparent bias perhaps. No question the liability issue isn't resolved (and I don't have all the answers), but the question is if the liability issue is the only issue (albeit a big one), can the lawyers get comfortable with the risks versus the benefits in this case?
  • David Reim
    The first thing that leaped into my mind, if I was a brand manager, was the liability issue. If you read the Physician side of the site, American Well says that it provides supplemental malpractice insurance but I would want a bullet proof assurance that in the case of a misdiagnosis or bad treatment decision made by a physician who was arrived at via my branded site would not set my deep pocket employer up for a huge problem.

    Two other quick observations:

    1. This is really just an evolution of the "Find a Doc" feature that has been on branded sites for 10 years. Now it's "Connect to a Doc".

    2. Obviously this does NOT eliminate the middleman but what it does do is lower a barrier to getting rapid care.

    BTW, I showed it to my physician wife (who is open minded) and she had lots of questions. She felt that there were many, many things that you could not diagnosis (and therefore treat) without physical data (like temp or BP) or an examination. However, she did agree there were conditions that could be handled such as allergy, ED, or insomnia (although that last one raised the question of doctor shopping for meds).
  • Great comments, David. I don't have all the answers on the liability issue. That would be a great one for someone's legal team to weigh in on. And, yes, this doesn't actually eliminate the middleman, as my provocative title suggests, but it does eliminate a middle-process (if there is such a thing). That is, you eliminate the need to make another step, which is actually setting up and appointment (and keeping it) with your doctor.

    Thanks for the primary research with your wife. Agree that this isn't for everything and you'd have to rely on patient inputs quite a bit (i.e., "what's your temperature?"), so it only works for some conditions. ED was a great thought. Many men are embarrassed about talking about this with their doctor live and in person, so why not reduce that barrier by doing this online? Interesting. Hadn't thought of that. There's probably some other conditions that have an embarrassment factor that could be a good fit as well.
  • I think this is a brilliant idea. Everyone is winning in this scenario. Wes, I think you take the idea to far. Sure it would be great to talk to a doctor but personally I'm going to go in for, blood pressure, temperature, etc. I think its a bad idea to let consumers play doctor.

    To play devil's advocate, what happens if a doctor gives a faulty diagnosis to a patient on a Pharma site that is using the service? Something bad happens based on the diagnosis and the patient sues for 25 million and the Pharm Co never says the words "social media" again. That would be bad.

    -Marcus
    .-= Marcus Andrews´s last blog ..Marcus_Andrews: RT @chrisbrogan Trust Agents Now a New York Times Bestseller http://bit.ly/4Fkll</a> =-.
  • Good question on the diagnosis and liability issue. I'm not sure how this is handled. American Well is already doing this on behalf of insurance companies, so this question must have been asked along the way. I wonder if there's an iron-clad release that patients must use before being allowed to use the service. I do know that the doctor would have liability in a case like this since he or she gave the faulty diagnosis just as they would if they did it offline.
  • Wes Michael
    In time there is no reason patients can't have a blood pressure cuff that attaches via usb to the laptop, a thermometer, and a sharp spotlight that lets the doc get a good look when you say "Ahhhh." If it makes economic sense, in the long run, it will happen.
  • Jose
    Excellent idea. And really the (positive) direction we are going with primary care. Much, if not most, of quality primary care is cookbook and protocol-driven (and rightly so). This is a natural, and necessary, step for PCPs to catch up with the rest of care by providing on-demand, efficient, low-cost care. Bravo!
  • is Jonathan that naive?
    This was meant to be sarcasm right? Docs who's income is dependent on referrals from a drug company might not be paid by a drug company but they don't give you unbiased advice obviously. We see it all the time with direct to consumer advertising and this is just an attempt by drug companies to keep their profits up and avoid people from getting a generic. Let me guess. you are related to or work for pharm or are just a little naive?
  • I don't think I'm naive, but thanks. You should check out how American Well works. It's independent. Physicans get paid by American Well and not the pharma company. This could (and probably should) be done in such a way that the physicians would have no idea what site or company the service appeared on. That would make it unbiased exactly how American Well works now with health insurers. Why is supplying access to a doctor for free so bad?
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