How Do Drug Firms Get New Pills In Front of Doctors?

How indeed? The U.K NHS has never been the fastest at adopting new medicines and technologies, and the emergence of new, regional-level gatekeepers looks set to make things worse.

As U.K health care reforms grant commissioning powers and budgetary levers to local groups of community doctors, with similar decentralization in other European countries, including Spain and Italy, a big question for drug firms is how to get their new pills in front of those community doctors. They no longer have battalions of sales reps. Nor, we're told, can they rely on the use of key opinion leaders (KOLs), since they're mainly hospital-based specialists, while adoption decisions are being made by a mix of advisors, managers and local doctors, many of them new to the process.

"Through no fault of their own, many of these people don't have the necessary experience or skills to understand what is being put in front of them, or to make informed decisions on new technologies," says Sally Chisholm, head of a small group of NHS planners, called the NHS Technology Adoption Centre (NTAC).

NTAC is attempting to accelerate adoption of new drugs and technologies in the U.K, having spent the past four years looking at the widespread, numerous and often unexpected barriers to uptake.

It appears that some basic skills are lacking when it comes to exchanging the old for the new. Quite often, Chisholm reports, no-one knows the steps that need to be taken to adopt a particular technology, how to measure the change that it causes, or how to halt or decommission traditional practices. "It really is quite tricky," Chisholm said.

NTAC's still tiny -- just 12 researchers -- and it has remained largely under-the-radar since its 2007 inception. But the group has intimate knowledge of procurement, budget setting and process management within the NHS, and is now starting to come up with structured procedures that can be followed by industry and doctors to speed the adoption of new technologies. For example, it has shown how barriers could be overcome to adopting a lymph node assay to check, during an operation, if breast cancer has spread. The barriers to adoption include its effects on operating theatre use, and nurse rotas, in addition to the actual cost of the assay.

Small wonder, then, that NTAC is beginning to attract interest from drug firms keen to explore its expertise to help them overcome adoption barriers. They may even be willing to fund its work.

NTAC wants to avoid any accusation of being an industry mouthpiece, although Chisholm says she is not averse to industry commissioning its work. A similar NHS organization, the National Institute for Health and Clinical Excellence (NICE), has in the past piloted the provision of advice, for a fee, to other organizations and companies.

Thus far, NTAC has produced an online tool called "generic adoption process" to help NHS organizations, and has pulled together some detailed analyses of approved technologies it believes the NHS should take on.

NTAC doesn't endorse the use of products in the same way that NICE does. It just provides a roadmap of how a new technology could be adopted, after it has been granted approval. As the route to new tecnology and drug adoption gets more complicated, NTAC's roadmaps could yet emerge as an increasingly important tool for drug firms seeking to get their products introduced into clinical practice.