Doctors may be writing prescriptions but fewer are actually shopping for the medications. In a piece posted by The Wall Street Journal, Kendall French explained that she's one of the many pharmaceutical representatives who has started re-strategizing sales pitches. In the past she'd communicate with doctors face-to-face but recently she's had to tell administrators about new medications. Not only are doctors losing partial say in these conversations but this could echo a number of changes throughout the health care industry.

Budgets at the forefront
In the past, French would drive profits by highlighting the benefits of new medicines and now she's had to switch it up to include more about prices. Doctors aren't completely absent throughout the process, as they meet with administrators to go over the sales pitches, however, budget could be a determinant in whether or not a drug is chosen despite benefits. The WSJ reported that many hospitals have been able to control expenses by eliminating communication between doctors and pharmaceutical companies. 

The financial situation among many treatment facilities demonstrates the possibility of this shift. The Hawaii Health Care Systems Corporations told KITV News that the institution is facing a $30 million deficit, which has forced them to close down several departments including a psychology unit. Affordable generic brands could be a saving grace for facilities faced with tough budget cuts. This might only seem like good news, however, as generic alternatives don't do the exact same thing that their name brand counterparts do.

Bolster generic market
Generic medications have similarities but aren't identical copies, according to Forbes. The news provider referred to these substitutions as "biosimilar". Despite not offering the same treatment as brand names, they've made their way into mainstream markets in a number of ways.

In one example, a generic hormone drug was created to provide similar results to Pfizer's Genotpropin. Initially the alternative, Omnitrope, wasn't very popular but pharmaceutical companies learned how to leverage their product by focusing on financial rather than medical incentives. They began distributing the drug by basically giving it away to people who couldn't afford it, a method referred to as patient assistance. Insurance companies would receive a rebate whenever a patient would hand over a prescription for it. Once it caught on, the drug slashed its price to 40 percent less than its competitors. Although Omnitrope ultimately did not outdo Pfizer's version, it exemplifies that the price tag of a medicine might be more important than its effects – it just took a little while.

Hinder medication decisions
Although less expensive medications are a good thing for people who can't afford them, generic competition has the potential to reduce the number of choices patients have when it comes to picking out pills, inhalers, treatments and more, affirmed The WSJ. This could occur because less expensive "biosimilar" medicines might replace their name brand counterparts altogether.

It's one thing for a facility to offer an item at a better price for the patient but it's another when it no longer becomes an option. This could lead into less choices in medications and also fewer options for private health facilities because private practices might not have the financial means necessary to do business with pharmaceutical companies and insurers.

While the long-term effects are still to be seen, the shift in decision-making from doctors to administration will alter the landscape of health care. The changes will echo to insurers, pharmaceutical companies, other doctors and patients. Whether its for better or worse will be determined with time.