Robert Dela Gente loves the big, shiny kiosk in his office hallway.

Several times a day, the family physician enters a code on its small screen, opens a drawer containing samples of nearly two dozen generic drugs and hands a bottle to a patient. He repeats the exercise enthusiastically because, he says, many of his patients often can’t afford more expensive brand-name medicines.

“I call it my ATM,” said Dela Gente, 32, who practices with several other doctors in a busy office in Oakland, N.J. “It’s just like having a closetful of brand-name samples, but this holds down costs.

“It’s tough enough for a patient who has to take a medication, but you don’t want them to get a prescription for something that’ll break the bank. This helps them get started on something they can afford.”

The kiosk – which resembles a soda vending machine – is the latest idea in the effort to restrain health-care spending. Created by a small company in San Diego called Medvantx, the contraption is slowly making its way into doctors’ offices in several states with the wholehearted backing of some big health insurers.

The reason is simple: Brand-name prescription drugs are getting more expensive all the time. In the 12 months ending last June, for instance, the average increase in the most widely used brand-name medicines was 6.3 percent, according to AARP, the consumer-advocacy group. By contrast, generic prices held steady during the first half of 2006.

To fight back, health insurers are promoting greater use of generics. A favorite tactic is to require health plan members to pay more out of pocket for brand-name medicines when comparable generics are available.

To further encourage doctors, several insurers in eight states, including New Jersey, Pennsylvania and California, are working with Medvantx to promote its kiosk. As insurers see it, the kiosk serves as a counterbalance to the tens of thousands of sales reps employed by big brand-name drugmakers such as Merck, Novartis and Pfizer.

“We’re not saying brand-name drugs aren’t good,” said Richard Popiel, vice president and chief medical officer at Horizon Blue Cross Blue Shield, the Newark, N.J.-based insurer. “But when it’s appropriate, people should use generics. Everyone’s health-care costs are rising.”

Although Pfizer recently made headlines with plans to reduce its U.S. sales force by 20 percent, no one is predicting sales reps will disappear any time soon. This means doctors will continue to receive armloads of free samples of brand-name medicines to distribute to their patients.

For generic drugmakers, there’s no point in employing huge numbers of sales reps when a doctor can write a prescription for a generic medicine and a pharmacist is free to dispense any version. A patient may be given a prescription for amoxycillin, an antibiotic, but several generic drugmakers sell copies.

“There is not a need for a large sales force,” said Carol Cox, a spokeswoman for Barr Laboratories, a big generic maker based in Woodcliff Lakes, N.J.

Still, this places generic drugmakers at a disadvantage. That’s because samples have a big influence on a doctor’s prescribing habits, ahead of medical-education meetings and face-to-face interactions with sales reps, according to a survey of more than 4,000 doctors by Verispan, a market-research firm.

“It’s sort of stunning when you realize that most every doctor with a sample closet has nothing in there but brand-name drugs,” said Robert Feeney, Medvantx’s chief executive. “What we’re trying to do is create access to generics for those doctors. It’s all about creating a level playing field with the branded drugs.”

A statement from the trade group for brand-name drugmakers, the Pharmaceutical Research and Manufacturers of America, did not specifically address the kiosks, but did say generics play an important role in health care.

Manny Tzavlakis, an associate partner in the health-care practice at Fair Isaac, a consulting firm, believes the kiosk is so convenient that many doctors will find it irresistible. Suddenly, the kiosk will be just as easy to access as the infamous sample closet – and that may eventually prompt some doctors to write fewer prescriptions for brand-name drugs.

“It’s an ingenious idea,” he said. “I think this is the competition the brand-name pharmaceutical industry faces going forward. It will be competition for the drug rep, because it’s really all about changing behavior – the doctor’s behavior.”


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