Sex, Lies and Pill Pushers: Confessions of a Big Pharma Drug Rep
Sometimes you just know.
Sometimes an aspiring whistleblower confirms what you always sort of believed about a given industry on a gut level, but never had the sources to confirm. And sometimes. Well, sometimes, it’s even worse than you imagined. Sometimes, even for an investigative reporter, you wish you hadn’t asked.
Joselyn, as we’ll call her, is in her early 40’s and stunningly beautiful. Large eyes. Thick hair. Elegantly refined and immediately, palpably sensual in a way that men instinctively sense and other women despise. Endowed with a dramatic and glistening curvature of lips and mouth that match the rest of her, she sits at the hotel bar and heads turn. We talk. She tells the story of a life and career defined by ambition and filled with the promise and skill of a woman who knew early what and who she was and where she wanted to go. As she shares the unremarkable details of an All-American childhood, it’s easy to imagine her in her younger days as a cheerleader, full of pep and social charm that she eventually honed to a sharp edge of flirtatious humor. Easy on the eyes, extroverted, articulate and nearly overpoweringly magnetic, it’s equally easy to wonder if Joselyn’s pathway into pharmaceutical sales for a household corporate name was her choice, or whether it chose her. Or maybe both, in the way that happens to so many of us whose intellect, palette of skills and talents creates a path of least resistance that’s as much about who we were born to be as what we work our asses off to become. 25 years later you wonder which tale wags the dog. Or, tail.
Then there are the prices we pay, when that one thing we always dreamed of doing carries hidden costs and unintended consequences and conflicts of soul and principle that can often overshadow even the most rewarding success and rapid ascent up the ladder. Satisfaction and fulfillment gone in a cloud of compromise or a lynchpin moment of disgust. For Joselyn, whose stark unveiling of sexual harassment, sex-for-compensation, pay-for-play corruption and workplace discrimination could fill the pages of an instant bestseller, it’s obvious that those hidden traps and costs have created a resume as filled with sadness and anguished regret as with the hard-won prestige of being one of the very best at her trade in a hyper-competitive industry of pushing pills to pill pushers and convincing doctors that one brand of erection pill is better than the other. Four out of five satisfied wives agree.
Over her string of cranberry vodkas and my Stella bottle, she wades into it, pensively at first, her eyes fixed as far away as her voice and her words slow and dreamlike. The early stuff is obvious. She traces the lipstick print on her highball glass and lays it out.
Pretty girls and guys get the jobs. Drug reps are hired meat. More leg. More cleavage. New boobs. Tighter suit. Shorter skirt. Doctors like to look. Boys and girls. Doctors like visits from good looking people. Some doctors expect much more than that. Don’t waste my time. It’ll just take a minute. Just a quick blowjob or a f***. C’mon, honey, it’s just business. Everyone else does. Why won’t you?
In a field where the average gun doesn’t see their third year, sustained productivity and ever higher sales goals and move-the-merchandise quotas are the coin of the drug representative realm. Put up the numbers, you stay. Have an off month, off quarter, off year, good luck in future endeavors. Between sips from her glass and grazing my arm in lengthening caresses for dramatic effect, Joselyn depicts a life spent in airports and motels and doctor’s offices and hospitals in cities across the country. Denver. Minneapolis. Fargo. Sioux Falls. Kansas City. Bismarck. Rapid City. Omaha. Des Moines. Wash, rinse, repeat. Groundhog Day on Fentanyl. Or, Vioxx. Or, Lipitor. Or, Levitra.
The pressures are immense, Joselyn says, every moment of every day to optimize strategy, identify whale clients, whittle down to premium lists of docs and practices who carry large patient loads, boast full waiting rooms and empty sample packets and prescription pads with lightning speed. The box movers and bottle shakers who aren’t afraid to introduce new products, push old ones for off-label use and maximize drug loads to their long lists of well-insured patients with high reimbursement rates and ever increasing lists of symptoms and complaints.
Move the product. Move up the food chain. And ultimately, maybe get off the street to a management position, teaching the hot new reps how ply the skin trade and sling the pills. If you’re lucky. If you follow orders. If you do what you’re told you have to do. And do it well.
I’d been servicing his practice a while. I knew what he from wanted me, for years. He was old and gross, but a huge ego. He expected women to do his bidding. He’d touched me a few times and put his hand up my skirt once but I’d brushed it off. Laughed. Walked away. Tried to avoid seeing him. Tried to conduct business over the phone. Did everything I could to stay away.
Joselyn takes a deep drink and then lurches away from the soap opera narrative to spill equally juicy bits about the way pharmacies and insurance companies REALLY work. The way they plot together to give you less of what your doctor wants you to have and even offer commensurate incentives for reducing per-patient costs over prescription expense. Drug companies hate the pharmacy-insurance codependency like the plague. It means fewer pills out the door and fewer patients on the hook. She knows the percentages and ratios by heart.
15% of people you tell ‘NO,’ don’t come back for that service. Initial rejections or requirements for prior authorization of expensive medications result in an off-the-top 15-20% reduction in insurance company costs related to prescription coverage. Delay, delay, delay. Insurance companies actually incentivize pharmacy companies and even individual pharmacy techs who can push off a client refill for days a month. A three day delay in refill saves the insurance company one monthly refill a year. Five days delay saves two months refill. One week a month saves three months a year in refills. On drugs that cost $5,000 a month, it’s cheaper to pay pharma-techs to play incompetent than it is to refill a prescription. Pharmacy technicians get gold stars and vacations and bonuses from insurance companies for ‘cost savings per patient,’ which is really just another term for bad service that directly contravenes a doctor’s orders to their patient and can even risk a patient’s life. Doctors and patients retaliate by overprescribing and overdosing to compensate for the days without medicine and the whole dance starts again…
Listening to Joselyn describe the inner workings of an industry we’ve all long known and suspected of being dirtier than dirty, I suddenly wonder if it’s a sign of cynicism or age that the details of corporate collusion to frustrate customers and minimize costs matter more to me than the oversexed Falcon Crest meanderings of spoiled, sordid doctors and their view of pharmaceutical reps as easy bedroom talent. I’d have been even more interested and unsurprised if she’d told me that these armies of buxom eye-candy pillcase carriers had parlayed their physical charms and favors into widespread blackmail and leverage over those same scumbag pariahs in clinical trials, etc., etc. I’d have been shocked to hear otherwise. Before leaving time to actually ponder, Joselyn’s rapid fire mouth of ruby lips and bleach-white teeth is firing again, back in the direction of the concupiscent carnality of a medical-social set that leads national statistics for everything from divorce, harassment payouts, divorce settlements and suicide. The costs of doing business. Or, doing the business.
So, I’d complained for months to my supervisor about this one doc who by this time was starting every conversation with me with an open proposition for sex. I told my supervisor I didn’t want to call on the creep anymore. No more. And do you know what he said? He told me to take one for the team. He told me that the doctor had cut his prescriptions for (brand name redacted–the company’s leading pain relief medication.) Our number one drug. Market gorilla. My supervisor told me that that doctor ONLY wanted to see me and that he would only restart writing that medication if I fulfilled the deal. So, basically, I was ordered by my boss to give in to sex by coercion just to make an extra couple million a year for the company. What a trip. Wish I’d have recorded it. You’re a writer? An investigative journalist? Maybe do my story? Write my book? Catch the f*ckers red handed?
Somewhere in the conversation, Joselyn tells me that her marriage is a walking corpse. Divorce is imminent and the whole family knows it. Kids are nearly grown. One off to college and one close behind. Kids are fine but sad about it. Besides the ‘take one for the team,’ routine, she’d had a few other affairs along the way. A fellow rep. Another doctor. A politician in a neighboring state. Just a few. A few too many for husband’s taste. Discovered texts. Big blowup. He watches her phone. Or, the children do it for him. The usual. It’s a matter of time.
I find myself in an odd transitioning of fascination, to flattered attraction, to pity, to grieving compassion. It’s clear the price she’s paid for the blurred lines and boundaries and the jostled demands of work and home and quota and obligation. It’s a sad regretful refrain that leaves me feeling like a doctor or a therapist listening to a client in crisis. I don’t need the ending, but she delivers it anyway, with a forlorn, on the verge mixture of tears and resignation. Detailed. Stark. Perfunctory and sad. The death knell of a soul spilling out.
We did it in a storage closet at his practice. Just a blowjob. I couldn’t manage more. We didn’t speak. It was just expected. Drop the pants. After I’d agreed to come back to calling on him, it was the understood precondition. It didn’t even seem real. It was only a few minutes and it was lifeless and empty and boring. I went through the motions and tried to occupy my mind elsewhere. Wondering why I couldn’t have told both my boss and the doc to pound sand and threatened them both with a lawsuit. Knowing that I’d be blackballed out of the industry. Arguing with myself that everyone knows this is just how it goes for certain clients. Move the merchandise. Meet the quota. Move the pills. Wondering why I’d ever done this job to begin with or whether I would have if I’d know everything it involved on the very first day…
I took one for the team.