Physicians’ Assistants, Nurse Practitioners Are Lucrative Target for Pharma Marketing

As noted in the last issue, physicians’ assistants (PAs) and nurse practitioners (NPs) have been playing an increasingly important role in the U.S. medical arena and are a ripe audience for pharmaceutical marketing (PDMSN, Aug. 14).

As of 2005, PAs and NPs had broad prescribing authority — with some limits on controlled substances — in 48 and 42 states, respectively. They wrote slightly more than 10 percent of all prescriptions in the U.S. While NPs make up a larger share of prescriptions in sheer numbers — 6.5 percent versus 4.1 for PAs — each PA on average wrote 2,100 prescriptions per year, 38 percent more than the 1,500 written by each NP.

What They’re Prescribing

Figure 1 below, based on 2006 data from Verispan, looks at prescriptions in the top 25 therapeutic categories. It shows that PAs and NPs prescribe much the same kinds of drugs as primary care physicians, a mix of acute care drugs such as pain medication and antibiotics, as well as chronic care drugs including antihypertensives and anti-diabetics.

The table also shows that PAs and NPs have similar prescribing patterns. Both groups write pain management drugs more often than any other category and prescribe a considerable amount of antihypertensives and oral antibiotics.

Figure 1 - Top 25 Therapeutic Categories

Devil in the Details

The average PA generates 38 percent more prescriptions per year than the average NP, and any category in Figure 2 below where the “productivity difference” between PAs and NPs is close to 38 percent is attributable to this.  On the other hand, where a productivity difference is substantially lower than 38 percent, it means NPs are more likely to write prescriptions for that category than PAs. Conversely, if the difference is substantially higher than 38 percent, it’s an indication that PAs are more likely to write prescriptions for that category than NPs are.

Based on these rules of thumb, you can see some differences in the kinds of patients PAs and NPs tend to see. For example, NPs are substantially more likely to treat female patients, prescribing more oral contraceptives, hormone replacement and vaginal therapeutics.  In contrast, PAs see an older patient base, reflected in the fact that they prescribe more anti-arthritics and pain management drugs.

On the whole, however, the prescribing patterns of NPs and PAs are similar enough that in general PAs and NPs can safely be treated as a combined target audience for marketing purposes.

Figure 2 - PA/NP Productivity (TRxs per PA or NP)

The final table shows total pharmaceutical marketing expenditures for the period from 2003 to 2006. A close look yields some interesting revelations about just how important PAs and NPs are to pharmaceutical companies.

In actual dollars, pharmaceutical companies allocated $1.8 billion to the PA/NP target audience in 2006, which is $700 million more than in 2003. As a percentage of overall marketing spending, the share aimed at PAs and NPs has increased from 7 percent in 2003 to 9 percent in 2006. At the same time, overall marketing expenditures by pharmaceutical companies increased by $3.9 billion, meaning that PA/NP marketing was a bigger slice of a bigger pie.

As a share of total marketing spending aimed at medical professionals, PA/NP marketing has increased from 9 percent to 12 percent between 2003 and 2006 — and PA/NP spending is growing more rapidly than the professional segment as a whole. This is not surprising given the buzz in recent years about declining returns from the “sales-force arms race” aimed at physicians. What is striking, however, is that despite all the attention focused on DTC advertising, PA/NP spending is growing more rapidly than that segment as well.

Since the pharmaceutical industry is fairly adept at measuring how responsive audiences are to marketing efforts (particularly when we’re talking about healthcare professional audiences where it’s possible to measure actual prescription activity), this rapid growth signals that promotional efforts aimed at PAs and NPs are providing a solid return on investment. — Todd Clark