Cost-Effectiveness of Prescription Drugs, Summaries of Community Health

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The Pharmaceutical Industry:

Challenges and Opportunities

Pharmaceutical Industry Overview

Importance of Pharmaceuticals

Pharmaceuticals are arguably the most socially important healthcare product. Pharmaceutical development is a big-risk undertaking, in which many promising leads prove disappointing.

Geographical Regions

The regions with the highest pharmaceutical sales are the U.S., Western Europe, and Japan. The U.S. accounts for about 50% of the world's pharmaceutical revenues.

Industry Growth Factors

Population growth and increased life expectancies have fueled recent growth in the pharmaceutical industry.

Pharmaceutical-Genomic Partnerships

According to the manual, partnerships between pharmaceutical companies and genomic companies will not prove immediately profitable.

Cost-Effectiveness of Prescription Drugs

Prescription drug therapy is cost-effective for insurance companies and healthcare providers. The high price of healthcare is not explained by the high price of medicines.

Pharmaceutical Marketing Techniques

Direct-to-consumer (DTC) advertising is one of the oldest and most effective pharmaceutical marketing techniques.

Factors Influencing District Structure

The number of districts in a region is influenced by the region's population.

An example of the regionalization of healthcare delivery systems is the different prescription reimbursement policies in California and Florida.

Pharmaceutical Sales Structure

The regional manager is not the heart of pharmaceutical sales. Most district managers (DMs) did start as representatives. A typical district has 8 to 12 territories.

Effective Sales Techniques

Comparative selling is the most effective method for grabbing market share. Pharmaceutical representatives do not mainly visit pharmacies. It usually takes more than 1-2 calls to a physician before they commit to prescribing a product.

Pharmacist Dispensing Practices

The pharmacist may dispense a product other than what the physician prescribed.

Healthcare Payers

Employers are considered 'payers' according to Chapter 12 of the manual.

Defining Ethical Pharmaceutical Companies

According to the manual, researching and developing novel drugs defines 'ethical pharmaceutical companies'.

Pharmaceutical R&D Investment

The continued investment in R&D by the pharmaceutical industry has not resulted in a disappointing number of new drugs being approved and in development.

Impact of Modern Medicines

Thanks to modern medicines, people newly diagnosed with HIV are expected to live another 50 years. The average American lifespan has increased by almost 30 years since

Clinical Trials and Drug Development

Treatment Groups

A treatment group is a group of patients assigned to receive a specified treatment.

Blinded and Double-Blinded Studies

In a double-blinded study, neither the study staff nor the study participants know which subjects are in the experimental group and which are in the control.

Asymptomatic Condition

'Asymptomatic' means not exhibiting signs or symptoms.

Physiology

Physiology denotes the study of bodily functions (as opposed to structures).

Definition of a Drug

In its broadest definition, a drug is any substance that produces a physical or psychological change in the body. The Federal Food, Drug and Cosmetic Act (FFDCA) defines a drug as any substance intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease, or a substance other than food intended to affect the structure or function of the body.

Vitamins

Most of the body's required vitamins must be taken in from outside the body.

ADME Testing

ADME testing measures the rate at which the body absorbs the drug, distributes it to the organs necessary to produce the desired effect, metabolizes it into waste material, and then excretes it from the body. ADME testing is primarily used in the field of Pharmacokinetics.

Placebos

Placebo effects can lead to withdrawal symptoms.

Drug Development Process

On average, only about 5 out of 4,000 drugs studied in the laboratory are eventually studied in people.

Sublingual Drug Administration

Sublingual drugs are absorbed directly and almost immediately into the bloodstream.

Rights of Drug Administration

Three of the seven rights of drug administration are the right patient, right drug, and right dose.

Pro-Drugs

Pro-drugs are administered in an inactive form, which is metabolized into an active form.

Age-Related Changes in Drug Excretion

The kidney of an 85-year-old person excretes drugs only around 50% as efficiently as that of a 35-year-old person. The normal age-related decrease in kidney function can help doctors determine an appropriate dosage based solely on a person's age.

Caplets vs. Tablets

Caplets are shaped like capsules and have film coatings to aid in swallowing, differentiating them from tablets.

Prescription Drug Labeling

The legend 'Caution: federal law prohibits dispensing without a prescription' is found on the label of all prescription drugs.

Slow Acetylators

Drugs that are metabolized by N-acetyl transferase tend to reach higher blood levels and remain in the body longer for slow acetylators. About 50% of the people in the U.S. are 'slow acetylators'.

Drug-Drug Interactions

Drug-drug interactions are not always harmful. Smoking decreases the effectiveness of some drugs.

Dietary Supplements

Interactions with drugs are a concern for dietary supplements, despite them not being classified as drugs.

Ideal Drug Characteristics

The 'magic bullet' concept, as phrased by Ehrlich, does not exist. An ideal drug would be aimed precisely at a disease site and would not harm healthy tissues.

Resistance vs. Tolerance

Tolerance refers to a person's diminished response to a drug after repeated use, while resistance applies to microorganisms' or 'cancer' cells' abilities to withstand drug effects.

Adverse Drug Reactions

Between 3% and 7% of hospital admissions in the United States are estimated to be for the treatment of adverse drug reactions. There is no universal scale for quantifying the severity of an adverse drug reaction. Noncompliance is a serious public health concern because it increases the cost of medical care.

Pharmaceutical Regulations and Patents

Patent Protection

Companies can be granted patents for drugs, manufacturing processes, and new uses of existing drugs. Drugs' trade names are often unrelated to their intended use.

Generic Drugs

Generic drugs are usually equivalent in quality to the brand-name drugs for which they are marketed as equivalents. Generic drugs account for about 20% of the total pharmaceutical market. Biologics do not cause immune responses, which is an incorrect statement. 'Large molecule' products are developed and manufactured through biological processes, not chemical processes.

Pharmacological Concepts

Agonists are drugs that attract or bind to cell receptors in order to mimic or enhance activities by endogenous chemical messengers.

The mechanism of action denotes how an active pharmaceutical ingredient (API) works in the body. Binders cement the active and inert components together to maintain cohesive portions.

Medical Abbreviations

'BID' denotes twice a day. 'PRN' denotes 'as needed'.

Brand Name vs. Generic Drug Differences

Differences in inactive ingredients can cause patients' different reactions to brand-name and generic drugs.

Drug Response Factors

Not all cells have a nucleus. The patient's genetic makeup, age, body size, use of other drugs and dietary supplements, other conditions or diseases, and whether the patient takes the drug properly can all affect drug response. Drug reactions are not predictable because they can occur after a person has been previously exposed to the drug one or more times without any allergic reactions.

Pharmacokinetic Concepts

The typical relationship between a drug's site of administration and site of action is that they are usually somewhat removed from each other. Cmax refers to the peak plasma concentration on a measuring curve. Pharmacoprocesses is not a main concept in clinical pharmacology.

Routes of Drug Administration

'Transfugal' is not a route of drug administration. Intradermal drugs are delivered by injection under the skin. An example of intravenous drug delivery is an injection of anesthetic directly into the bloodstream. The major organs of the gastrointestinal system are the mouth, esophagus, stomach, liver, pancreas, gallbladder, small intestine, and large intestine.

Pharmaceutical Distribution and Pricing

Pharmaceutical Sales Structure

National account managers (NAMs) are normally responsible for selling to distributors.

Drug Wholesaler Practices

Secondary drug wholesale distributors sometimes buy their drugs directly from manufacturers. Large chain pharmacies are allowed to buy directly from drug manufacturers by FDA law. Three companies account for nearly 90% of all drug wholesale sales. Manufacturer-direct sales bypass the need for intermediary distributors. A group purchasing organization (GPO) is an entity consisting of two or more hospitals or other healthcare entities that negotiates contracts on behalf of its members.

Institutional Pharmacy Purchasing

Drugs dispensed by institutional pharmacies are, on average, 3 times larger than those dispensed by retail pharmacies.

Non-Stock Sales

Brokerage sales, dock-to-dock sales, and drop shipments are all types of non-stock sales. Rebates are another term for 'after-market arrangements'.

Pharmaceutical Associations

The PDMA is not the Prescription Drug Manufacturers Association, but rather the Prescription Drug Marketing Act.

Pharmacy Types

An independent drug store is a company that owns and operates three or fewer pharmacies.

Drug Labeling and Intellectual Property

Drug Package Insert Information

The usual dosage range is covered in the 'indications and usage' section of a drug's package insert information. Drug labels must include indications and usage information, as well as contraindications. The 'description' section of a drug's package insert information should include the drug's proprietary name and the established name.

Exclusivity vs. Patents

Exclusivity gives exclusive marketing rights, is granted by the FDA, and can run concurrently with a patent or not.

The key difference between exclusivity and a patent is that exclusivity is only granted upon the drug's FDA approval. For an invention to be worthy of patent protection, it must be novel, useful, and not obvious.

Generic Drugs

A generic drug is bioequivalent to the originator brand-name drug in dosage, strength, safety, and quality. The FDA's criteria for equivalency do not require the drugs to contain identical amounts of the same inactive ingredients. A generic drug is bioequivalent to the originator brand-name drug in dosage, strength, safety, and quality. The 'Approved Drug Products with Therapeutic Equivalence' list is generally considered the most reliable source of information on therapeutically equivalent drug products. 'AA' is an Orange Book rating. Biological equivalents are chemical equivalents which, when administered in the same amounts, will provide the same biological or physiological availability as measured by blood and urine levels. A generic drug is a drug that is identical or bioequivalent to the originator brand-name drug in dosage form, safety, strength, route, quality, performance characteristics, and intended use. Generic substitution denotes the dispensing of an unbranded generic product for the product prescribed. The duration of a patent challenge is 180 days.

Pharmaceutical Sampling Practices

The more visibility you can give your drug, the more likely it will be prescribed, similar to how a grocery store shelf displays products. Pharmaceutical representatives do typically store and secure their own drug samples. Sampling is sometimes the most important factor in a pharmaceutical rep's success. The FDA approves storage conditions for drug products. Pharmaceutical representatives must always record the amount of drug samples left and obtain a signature for that amount. The sale, purchase, or trade or offer to sell, purchase, or trade prescription drug samples is prohibited by Section 503 of the Federal Food, Drug, and Cosmetic Act, as amended by the Prescription Drug Marketing Act. The federal government does regulate the drug sampling for a pharmaceutical representative. Donating or selling prescription drug samples is not permitted by Section 503 of the Federal Food, Drug and Cosmetic Act. The United States Pharmacopoeial Convention issues monographs that define how drugs should be stored and what variance is allowed in their stated contents. Storage conditions for drug products are based on information supplied by the manufacturer.

Medications are usually affected by changes in temperature, light, humidity, and other environmental factors. Degraded drugs can sometimes still be used when the amount of remaining drug has not fallen lower than 85-90% of that stated on the label. Drug recalls are almost always negotiated with the FDA beforehand.

Electronic Prescribing Systems

Electronic prescribing systems can help improve problems such as patients 'doctor-shopping' for controlled substances, pharmacists misreading prescriptions, and physicians wasting time calling pharmacies.

Pharmaceutical Research and Development

Receiving Shipments from Employer

If you receive a shipment from your employer and notice that there are twice as many samples as what is posted on the packing slip, you should call your sales manager to inform them of the mistake and ask for instructions.

Costs in Pharmaceutical R&D

The area of pharmaceutical R&D that has seen the largest cost increases is clinical trials.

Timeline for New Drug Development

On average, it takes 10-15 years for a new drug to be developed, from the discovery of the initial compound to FDA approval.

Pharmaceutical Regulatory Agencies

The Pharmaceutical Research and Manufacturers of America (PhRMA) is an industry-based regulatory agency, run mainly by the companies themselves.

Factors Affecting Pharmaceutical R&D

Several factors have complicated the pharmaceutical R&D process:

An intensive regulatory process Growing demand in the medical community for more complex data about pharmaceuticals The increasing number of procedures in Phase III trials

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FDA Modernization Act of 1997

The landmark FDA Modernization Act of 1997 was a major step forward in enabling safe and effective new drugs and biologics to be made available sooner to patients.

Healthcare Delivery Systems

According to the manual, a market-based system is the best way to deliver healthcare.

Effects of Pharmaceutical Price Controls

Increased pharmaceutical price controls would stifle innovation in the U.S. healthcare system.

Research Investment Comparison

None of the following sectors invest a greater percentage of sales in research than the biotech sector: aerospace, communications, or electronics.

Bayh-Dole Act and Stevenson-Wydler Technology

Innovation Act

The intent of these acts was to hasten the commercialization of technologies that otherwise might not be used.

Pharmaceutical Industry in the European Union

The G10 medicines group recently reported that there is poor collaboration between publicly- and privately-funded research concerns in the European Union (EU).

Preclinical Pharmacological Studies

The aim of preclinical pharmacological studies is to obtain data on the safety and effectiveness of the lead compound.

Toxicity information in preclinical studies helps provide confidence about a drug's safety.

Pharmacological studies using animals are regulated under good laboratory practice.

Drug Composition

Drugs administered to patients do not only contain active pharmaceutical ingredients (APIs).

Drug Permeation

The drug's vesicles do not affect a drug's ability to permeate membranes.

Lipid-soluble drugs can usually pass through cell membranes.

Weak acid drugs are generally absorbed by the stomach more quickly than weak basic drugs.

Routes of Administration

Rectal administration does not completely bypass the liver.

Intravenous vs. Transdermal Administration

Intravenous drug dosages are easier to control than drugs administered transdermally because the entire dose is available in the bloodstream to be distributed to the target site.

Factors Affecting Drug Distribution

A drug's lipid-solubility, polarity, and the vascular nature of the drug's target tissue all affect its distribution to target tissues.

Transdermal Administration

The term 'transdermal' means 'to apply the drug on the skin surface'.

Carcinogenicity Studies

Carcinogenicity studies are carried out to identify the tumor-causing potential of a drug.

Ethical Guidelines for Clinical Studies

According to NIH ethical guidelines, the most important criteria in selecting subjects for clinical studies is the scientific objectives.

Institutional Review Board (IRB)

The statement that the members of the IRB/IEC must be experts in the topic of study is incorrect.

Blinding in Clinical Studies

Phase I and IV trials are often open label, but phase II and III are double- blinded or at least blinded.

Surrogate Markers

If it is not possible to measure the direct effects of a drug, surrogate markers such as blood pressure and cholesterol levels are used instead.

Case-Control Study

A case-control study is an observational study that first identifies a group of subjects with a certain disease and a control group without the disease, and then looks back in time (e.g. via chart reviews) to find exposure to risk factors.

Measures of Central Tendency and Variability

The mean is the sum of all observations divided by the number of observations.

Incidence is a measure that describes the number of new events that occur during a specified period of time in a population at risk for the event (e.g. lung infections per year).

The standard error of the mean is a measure used to describe the variability of the population mean.

Validity

Validity denotes the extent to which a test actually measures what it is supposed to be measuring, or what we think it is measuring.

Survival Analysis Methods

Kaplan-Meier analysis and Cox proportional hazards analysis are methods of survival analysis.

Clinical Paper Sections

The methods section of a clinical paper describes subjects' entry and exclusion criteria.

Clinical Trial Design Document

The document that sets out how a trial is to be conducted (i.e., the study's general design and operating features) is called the inclusion criteria.

Ethical Constraints in Clinical Trials

Geographic variations are not one of the ethical constraints that must be considered when designing and performing clinical trials.

Differences between 'Large Molecule' and 'Small Molecule'

Drugs

Large molecule drugs are mainly protein-based drugs that develop in biological systems such as living cells, while small molecule drugs are not.

Vaccines

Vaccines are not types of 'small molecule drugs'.

Attenuated vaccines are less expensive to prepare than inactivated vaccines.

Toxoids are derived from the toxins secreted by a pathogens.

Malaria

The estimated annual death toll for malaria is 1.5 to 3.5 million people.

Blood Cell Counts

There are more red blood cells than white blood cells for the same volume in the human body.

Insulin Sources

From the 1930's to the 1980's, insulin was primarily obtained from porcine and bovine extracts.

Cytokines

Interferons, interleukins, and monokines are types of cytokines.

Hormones

Blood glucose is not a type of hormone.

Gene Therapy Techniques

In vitro gene therapy is a basic technique in which patients' genetically faulted tissues are removed, loaded with normal genes in vectors, and returned to the patients' bodies.

Stem Cells

Pluripotent stem cells can develop into many cell types, but not a new individual.

Leukemia

Leukemia is a condition in which the bone marrow is unable to produce functional white blood cells to fight infection.

Gene Therapy Vectors

Retroviruses are a type of vector used in gene therapy.

Stem Cell Types

Semipotent is not a type of stem cell.

Vaccine Preparation

Insulin is not a way in which traditional vaccines are prepared.

Drug Therapy Benefits

Effective drug therapy is a cost-effective and highly valuable means of controlling total healthcare expenditures and improving quality of life.

Drug Utilization Review (DUR) Programs

DUR programs have traditionally been used to ensure the appropriate, safe, and effective use of prescription drugs, but are increasingly shifting their focus to minimizing costs.

DUR programs involve retrospective monitoring of physicians' prescribing patterns.

Formularies

A formulary is a list of prescription drugs approved by insurance coverage.

The history of drug formularies in the U.S. extends back to the American Revolution.

All of the following are types of formularies: - A closed three-tier formulary in which generic drugs are listed on Tier 1 - A five-tier formulary that is supplemented by a step therapy program - An open formulary that places few restrictions on coverage or access

Formulary Trends

The repeal of Hatch-Waxman is not a recent formulary trend.

Hatch-Waxman Act

The Hatch-Waxman Act made it easier for generic manufacturers to compete with R&D companies.

Opportunity Cost

Opportunity cost is the value of a sacrificed alternative.

Pharmaceutical Funding Entities

The three primary entities that fund pharmaceuticals are employers, the government (Medicare and Medicaid), and individuals.

Pharmacy and Therapeutics (P&T) Committee Members

A company's medical liaison would not be a member of a P&T committee.

Healthcare Coverage and Pharmaceutical Acquisitions

The statement that "Almost 98% of employed Americans are now covered by a HMO, a preferred provider organization, or a point-of-service plan" and that "pharmaceutical companies are more interested in acquiring and exploiting another's brand than in acquiring another's R&D and sales and marketing assets" is false.

Brand Strategy Development Timing

Ideally, brand strategy development for a new drug should begin during Phase II clinical trials.

Types of Brand Values

An example of an 'expressive' value is "I own a BMW because I want people to know that I'm a serious driving enthusiast".

'Uniqueness' is an example of a 'functional' value.

Pharmaceutical Brand Promotion

It is rare for pharmaceutical companies to explore, develop and promote expressive values with which patients might identify.

To be competitive, pharmaceutical brands must be distinctive, possessing defining characteristics that are perceived by customers to be unique, attractive and relevant to their needs.

With the global need for new drugs, pharmaceutical brand names are subject to regulatory approval.

Direct-to-Consumer (DTC) Advertising

DTC advertising has become an essential marketing tactic for both large and small brands over the last few decades.

Factors Influencing Prescribing Habits

Doctors' personal experiences and their patients' unique situations most strongly influence physicians' prescribing habits.

Pharmaceutical Spending

Pharmaceutical companies spend less on promotional activities than on R&D.

Advertising Strategies

A brand that treats a very common chronic condition would be most well- served by mass-market print and TV ads.

Diagnostic Test Fluids

Saliva is the least commonly analyzed fluid for conducting a medical diagnostic test.

Gold Standard Testing

The statement that "gold standard' testing achieves the greatest results among the diagnostic testing measurements" and that "gold standards provide the best understanding of what is happening to a patient so cost is not a factor when deciding to run these tests routinely" is false.

Risks of Diagnostic Testing

Every diagnostic test has some risk, such as the possibility of injury during the test or the need for further testing if the results are abnormal.

Genetic Testing Materials

Urine is not commonly used for examination to check abnormalities of chromosomes, genes (including DNA) or both in genetic testing.

Bone Marrow Testing

DEXA is the only method that may be used to make a definitive diagnosis of osteoporosis and to monitor the response to treatment.

Electromyography (EMG)

Electromyography (EMG) uses small needle sensors (electrodes) to record the electrical activity in selected muscles and peripheral nerves during rest.

Wearable and Implantable Test Technologies

Wearable and implantable test technologies currently in development will allow for constant monitoring of body chemistry and collection of previously inaccessible data.

Diagnostic Test Purposes

Diagnostic tests are used to detect, confirm, or rule out the presence of a disease or medical condition, not to provide a single purpose for scientific analysis.

Diagnostic Test Characteristics

Many diagnostic tests are considered to be of a general therapeutic nature and are not specified.

Osteoporosis Screening

The most sensitive screening tool to detect osteoporosis, a disorder characterized by fragile, weak bones due to a drop in bone mass and increased risk of fracture, is not the arthrocentesis diagnostic test.

Nervous System Disorder Signs

Diarrhea is not a sign of a nervous system disorder.

Electroencephalogram (EEG)

The electroencephalogram (EEG or brain wave test) is a non-invasive procedure used to detect and record brain wave activity.

Coronary Angiogram

A coronary angiogram is obtained by injecting an iodine-based dye or other contrast agent into the bloodstream and taking x-rays of the coronary arteries.

Prescriber Data Usage

Companies use prescriber data to conduct research.

PhRMA Code Acceptability

Under the PhRMA Code, the following are acceptable: - Modest meals for staff members attending educational events - Providing modest meals to staff members attending educational events

The following would not be acceptable: - Gifts that are only given to doctors with high prescribing volumes

PhRMA Code Enforcement

The PhRMA Code on interactions with healthcare professionals is only voluntary and not mandatory.

Promotional Items under PhRMA Code

Pens and clipboards designed to be used by patients in doctors' offices would not be considered acceptable promotional items under the PhRMA Code.

Patient Education Items under PhRMA Code

An anatomical model valued under $100 is an example of an acceptable patient education item under the PhRMA Code.

Pharmaceutical Industry Regulations and

Practices

PhRMA Code Restrictions on Entertainment and

Recreational Activities

The PhRMA (Pharmaceutical Research and Manufacturers of America) Code does not permit a company to provide entertainment or recreational activities to healthcare practitioners under any circumstances. The only exceptions are:

When the activity is intended to facilitate informational exchange. When the practitioner is acting as a bona fide advisory board consultant. When the practitioner is providing a legitimate service to the company.

Sponsoring Lunch at a Conference

Under the PhRMA Code, a company may sponsor a lunch at a 3-day conference, but only if the lunch is clearly separate from the CME (Continuing Medical Education) portion of the conference.

Office of Inspector General (OIG)

The Office of Inspector General (OIG) is an arm of the Department of Health and Human Services that investigates regulatory infractions, provides compliance advice, and brings enforcement actions.

Legality of Requesting Personal Information

It is false that it is illegal to ask receptionists for personal information about clients, such as home phone numbers, birthdays, or hobbies.

P&T Committee Functions

The primary goals or functions of the P&T (Pharmacy and Therapeutics) committee do not include educating sales representatives on legal and ethical guidelines for professional behavior.

Challenges in Family Medicine

One major challenge facing family medicine is managed care policies eroding patient-doctor relationships.

Proportion of Patients Diagnosed and Treated by Family

Physicians

According to the manual, family physicians diagnose and treat approximately 95% of the patients they see, as opposed to referring them to specialists.

Product Adoption Continuum

The steps on the product adoption continuum are: awareness, evaluation, and adoption.

Somatic Psychiatric Treatments

Drug therapy is a type of somatic psychiatric treatment.

Best Time for Office Visits to Psychiatrists

The last 10 minutes of each hour is usually not the best time to make office visits to psychiatrists, as they are usually on their way to the hospital at that time.

Drug Utilization Review (DUR)

Drug Utilization Review (DUR) is an MCO's (Managed Care Organization's) practice of monitoring prescribing patterns.

Short Call Protocol

The focus of the short call protocol is beginning with a specific patient type.

Medical Science Liaison (MSL)

The Medical Science Liaison (MSL) is someone employed by a pharmaceutical company who builds relationships with thought leaders and acts as an informational resource.

MSL Education

MSLs typically have graduate-level science degrees.

Judging MSL Team Contributions

Companies typically judge the MSL team's contributions based on return on education.

'Push Through' vs. 'Pull Through' Programs

'Pull through' programs involve sales representatives more than 'push through' programs.

Types of 'Pull Through' Programs

The types of 'pull through' programs include adherence/persistency, educational support, and therapeutic intervention.

Importance of Team Environment for Pharmaceutical Sales

Reps

It is false that pharmaceutical sales reps, who mostly work out of their homes, do not need to work well in a team environment.

Reasons for Lack of Doctor Interest in Clinical Studies

The most likely reason a doctor would lack interest in one of your clinical studies is that they do not like the way you are presenting it.

Researching the 65+ Market

Effective methods for researching the 65+ market include being a Medicare Part D information resource, knowing the physician-payer mix, and taking advantage of partnership programs.

Initiating Conversations at Hospital Displays

When a physician visits your hospital display, you should not begin the conversation by asking "Can I help you?"

Rules for Making the Most of Sales Calls

One of the rules is to focus on their agenda, not your own.

Specialty Care Products and Chronic Therapies

It is true that side effects that might be considered minor annoyances in acute treatment can be a powerful barrier to adoption in chronic therapies for specialty care products.

Acute Medications and Specialist-Initiated Therapies

It is true that in some medical cases, a therapy may be initiated by a specialist and monitored and maintained by a primary care physician.

Blockbuster Drugs and Orphan Drugs

Blockbuster drugs typically have sales of just under $10 million annually, while orphan drugs treat rare conditions.

Generic Drug Manufacturer Challenges

The greatest challenge for a generic drug manufacturer is often to replicate drug formulation factors that affect the pharmacokinetic and pharmacodynamic characteristics of the original drug.

Physician Office Call and Visit Duration

Most calls and visits to physicians' offices (excluding waiting and driving time) are relatively short in duration.

Managing Rumors

Countering attack is not a step in managing rumors.

"Going to the Next Level"

According to the text, staying focused is considered "going to the next level".

Retail Pharmacist Responsibilities

One of the primary job responsibilities of a retail pharmacist is dispensing pharmaceuticals.

Customer Categorization

Pharmaceutical companies and representatives do not categorize their patients, but rather their customers.

Medicare Prescription Drug Benefits

The Medicare Prescription Improvement & Modernization Act introduced Medicare Part D as a relatively new prescription drug benefit.

Pathogen Definition

A pathogen is a disease producer.

Primary Infection-Fighting Blood Cell

White blood cells play the most prominent role in fighting infection and disease.

Receptor Definition

A receptor is a structure that generally resides on a cell surface (or in the cytoplasm) and causes a biological change or activity when stimulated.

Renal Definition

Renal pertains to the kidneys.

Gene Mapping Definition

Gene mapping is the practice of locating genes on a chromosome.

Pharmacogenomics Focus

Pharmacogenomics is the field most concerned with drug effects due to slight genetic differences.

Government Abbreviation

The United States federal government is referred to as the USG.

IDN Definition

IDN stands for Integrated Delivery Network.

Small Molecule Definition

Small molecule refers to drugs that are non-biological (i.e., chemical) in nature.

Medical Abbreviation for 'Hour'

The medical abbreviation that denotes 'hour' is H.

Pharmacology Definition

Pharmacology is the study of drugs' beneficial and toxic effects on living cells, tissues, and organisms.

Organ Definition

Organs are specialized cells and tissues that work together to perform a specific body function for a common purpose.

Mechanism of Action Definition

The mechanism of action is the method by which a medication produces its therapeutic effects.

Plasma Definition

Plasma is the fluid portion of the blood.

Allergy Definition

An allergy is an extreme sensitivity and reaction to a foreign substance, including medications.

CNS Agent Uses

Central Nervous System (CNS) agents are used as analgesics, anesthetics, and anti-convulsants.

Cholinergic Agonist Mechanism

Cholinergic agonists work by mimicking the actions of acetylcholine.

Fibrinolytic Agent Function

Fibrinolytics are therapeutic agents used to promote blood clot formation.

Gastrointestinal Agent Types

Protein inhibitors are not a type of gastrointestinal agents.

Immune Globulin Recipients

Patients with weakened immune systems are most likely to receive immune globulins.

Iron's Primary Function

Iron's primary function in the body is carrying oxygen.

Anti-Infectant Types

Antimetabolites are not a type of anti-infectant.

Entry-Level vs. Experienced Resumes

Entry-level resumes are more likely to begin with the education section than the experience section.

Targeted Cover Letters

Targeted cover letters are always tailored to specific companies.