Drug companies depend on innovation to find blockbuster drugs. But when it comes to marketing to consumers, two pharmaceutical giants are taking cues from well-worn strategies in other industries.

Last month, Pfizer Inc. announced that Viagra users filling six prescriptions would be able to get a seventh for free. The promotion would reward loyal users at a time when Pfizer's market share is under siege from new competition.

Novartis followed more recently with another unusual offer: Patients who fail to control their blood-pressure on Novartis' drugs can get refunds. The company called this its "money-back guarantee."

These campaigns, along with other free-trial or rebate offers in recent years, represent the latest shift for an industry still relatively new to lobbing pitches at consumers - with come-ons more common in ads touting cellphone plans and airfare deals.

"I think that as [direct-to-consumer] marketing and pharmaceutical marketing has matured it has started to look at consumer marketing in general to see what best practices it can borrow," said Mary Brown, senior vice president and director of business development at the Quantum Group, a health-care consumer advertising agency in Parsippany.

Drug companies have long offered free samples of their brand products through physicians' offices. But offers appealing directly to consumers - and their wallets - are likely to resonate more today than in years past: Patients are paying more for prescription drugs as employers trim benefits or increase co-payments.

So, AstraZeneca touts a seven-day free trial for its Nexium drug for acid reflux disease. Aventis advertises on its Web site 40 percent off out-of-pocket costs for its Allegra allergy pill, up to $15. Women seeking Johnson & Johnson's Ortho Evra birth-control patch can get $5 off for their next prescription.

Novartis' money-back guarantee for its drugs Diovan HCT and Lotrel ties in with a patient-enrollment program called "Take Action for Healthy Blood Pressure." Nearly 60 million Americans are estimated to have high blood pressure, but only about 30 percent are adequately controlling it, and health advocates call it a "silent killer."

Novartis will launch a massive TV and magazine ad campaign that addresses blood pressure goals and the consequences of not managing the condition, without mention of the company's products. Other promotions in the program include a coupon for a home blood-pressure monitor and 30-day free trial of medication.

But the attention-grabber is the money-back opportunity. Patients can recoup up to four months of out-of-pocket costs if their doctors certify they failed to meet blood-pressure goals after taking the highest doses of Diovan or Lotrel. Novartis sold $777 million worth of Lotrel last year, all in the United States, and $2.4 billion worth of Diovan, making it the company's top-seller.

The money-back concept stemmed from 3,000 interviews Novartis conducted with patients and physicians, in an effort to understand the challenges in controlling blood pressure, said Bob Laverty, a company spokesman.

"The goal is to get them in to see their physicians and talk to their physicians about the program," Laverty said.

At least one other company has a similar offer. For its cholesterol-lowering drug Zocor, Merck & Co. has had a money-back guarantee, marketed to physicians through the company's sales force but not advertised, Merck spokesman Tony Plohoros said.

Any program that can motivate patients to bring their blood pressure under control would be welcome in principle, said Dr. Muhamed Saric, an assistant professor of medicine in the cardiovascular diseases division at the University of Medicine and Dentistry of New Jersey. But Saric said a doctor's first option should be to prescribe less-expensive, older blood-pressure medicines, citing a landmark federal study that supported their effectiveness.

"I wouldn't be surprised if the Novartis program in the end brings about a measurable improvement in the blood-pressure control of Americans," Saric said. "But what strings are attached?"

Meanwhile, Pfizer's "Value Card for Viagra" program comes as the little blue pill is encountering two new competitors, Cialis and Levitra, in a category Viagra owned for years.

Eligible men are those who pay full sticker price for Viagra or have only partial coverage; pills obtained with a co-payment don't count toward the Value Card. Viagra retails for about $10 a pill.

John Colaizzi, dean of the Ernest Mario School of Pharmacy at Rutgers University, said he would be less comfortable with the "buy six, get one free offer" if it were applied to other drugs beyond "lifestyle" medications. He said the temptation to get a free prescription might improperly induce patients to stay on a medicine that either is failing to work or causing adverse side effects.

"Some of these medications, you have to be clear that the continued use of it ... is done in a responsible way," Colaizzi said.

The wrinkles from Pfizer and Novartis are the latest experiments in the drug industry, which has promoted prescription drugs much more feverishly to consumers over the past five years.

Part of the trend stems from a 1997 decision by the Food and Drug Administration to clarify its consumer-advertising policy - a move credited with helping to grease the wheels for a slew of TV and magazine advertising to the public. At the same time, consumers have sought greater control over their health care decisions.

That latter trend, Colaizzi said, means that consumer advertising of medicines, while controversial, is likely here to stay.

"My sense is, it's kind of inevitable because you are dealing with consumers who are, year after year, more sophisticated in these matters, who year after year are a lot more interested in their health," Colaizzi said. "The best thing we can do is see how can we deal with [advertising] effectively."

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