The Hot and Cold Relationship Pharma Has With NPS and PAS

For decades, the primary target of Direct-to-Healthcare Professional marketing by pharmaceutical companies has focused on the prescribing MD. Over the past decade, there has been a subtle but important shift to building relationships with the nurse practitioners and physician assistants that work under those physicians as their size, daily role, and level of influence have all grown. That relationship has been hot and cold because Sales has focused a lot more on them than Marketing.

During the past several years, a majority of physicians (especially primary care) have seen dramatic changes in their practices – significant increases in patients due to the ACA (ObamaCare), an aging population, and additional time required to maintain EHRs. The resulting limited availability of PCPs, the new laws expanding prescribing abilities for NPs and PAs, the cost efficiencies those roles can bring to an office, along with the rise of urgent care centers and walk-in clinics, has placed more responsibility for patient care on these other healthcare providers (HCPs).


Prescription Trends of the NP and PA



IMS: Total Retail Prescription Growth for NPs and PAs – 2010 to 2015

2015 IMS statistics show that NPs and PAs are a growing force in the prescribing data and are not just relegated to taking vitals and managing paperwork/eRecords. Nationally, NP and PAs now make up 22% of the healthcare provider workforce.1 As of 2015, 17% of all retail prescriptions were written by Nurse Practitioners (NPs) and Physician Assistants (PAs), up from 9% in 2010.1 NPs and PAs combined wrote 676 million prescriptions in 2015 up from 327 million in 2010.1

The AANP and AAPA believe that the rate could be as high as 1 billion prescriptions from NP/PA clinicians in 2015 due to underreporting. This trend of increasing patient care and prescribing by NPs and PAs is expected to continue to increase, based on data from the Bureau of Labor Statistics showing that these two professions will grow twice as fast as MDs.2


Pharma Has Noticed…Kinda



American Journal of Managed Care December 2010

In addition to a larger role in patient care and writing prescriptions, NPs and PAs have been directly interacting with Pharma. Going back to 2010, a study already showed that 96% of NPs reported regular contact with sales reps and 66% reported giving out drug samples.3 90% also believed it was acceptable to attend pharma-sponsored promotional educational events, with almost half saying they would be more likely to prescribe a drug that was highlighted during an event.3 We spend our days engaging with offices to profile this attitude and in fact see much higher results in our intent-to-change prescription patterns.

Not only has the Industry noticed this shift in the role and prescribing behavior of NPs and PAs, but it’s been hit with pressures driven by the implementation of Sunshine Act laws regarding the limitation and transparency of pharma marketing and increased ROI demand that marketing teams show results (and therefore spread costs) across more healthcare providers. A lunchtime program with 3 physicians looks very different financially than the same program that includes 3 MDs along with 4 additional NPs and PAs. So there is an incentive to engage with these other prescribing roles in the office.


Few Marketers Proactively Target NPs and PAs

The above data showing regular interaction with Pharma has a small but important caveat – the 96% are in contact with Sales. As an agency, we can state that not many marketing teams proactively target the NP or PA when they pass us their target lists. We almost always need to ask where those records are and press upon the importance of including them in our Total Practice engagement plans.

Sales teams have understood for a long time, when you detail a physician, you detail their entire staff. The data above makes sense that NPs and PAs all speak with Sales Reps.

“Our pharma clients state that they achieve increased ROI in promotional programming campaigns where both MD and supporting staff are engaged and educated in concert.


Our Belief in the Total Practice Approach

That’s why, as part of our service offering, we operate a customer-service focused call center or engagement center as we call it. We know that our success is partially based on the same Rep principle of detailing the entire office. When we call an office – we are dealing with gatekeepers, medical assistants, office managers, nurses, and yes – NPs and PAs. Specifically, when we work with a client to provide customer service and educational events to offices – our services and the content we develop are uniquely positioned to serve the needs of the nurse, NP, and PA alongside the MD. This is because we are often dealing with patient education literature, samples, savings programs, treatment protocol and other relevant content aimed at supporting both the staff and their patients.

We’ve also seen a rise in the use of our Total Practice Virtual Education Lunchtime Details, where an entire office is scheduled to attend a remote live program on our webinar platform with a key opinion leader and one of our group learning experts. The entire staff attends an event recruited by evoEngage without the need of the Rep. We coordinate the program, materials and lunch reimbursement, adhering to policy limits and reporting needs.



This program is perfect for the nurse practitioner and physician assistant as it meets the needs of the physician while including the rest of the treatment staff. Often, a stronger consensus is reached among coworkers.

The Total Practice approach should be an important aspect of pharma marketing in order to take advantage of the impact that NPs and PAs have in patient care. Our Engagement Center profiles offices with behavior data as well as attitudinal surveying and office staffing and communication details. This has helped us routinely generate requests for materials in over 50% of a target list.

Contact us to get supporting case studies and learn more about our approach.