Pharma payments influence brand-name statin prescriptions

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Doctors who receive payments or gifts from pharmaceutical companies are more likely to prescribe brand name medications, Reuters Health reports a new study suggests. The rate at which doctors prescribed brand name drugs increased with the amount of money or gifts like dinners they received from drug companies, researchers found.

Lead author Dr James Yeh, of Brigham and Women’s Hospital in Boston, said doctors are taught how and what to prescribe during medical school. “After you leave, sometimes that kind of knowledge is derived from pharmaceutical salespeople,” he is quoted in the report as saying. Along with communications with pharmaceutical salespeople, doctors may also receive meals, subsidies or grants for continuing education and speaking fees from pharmaceutical companies.

Yeh and his colleagues write that some states require doctors to report what they receive from drug companies. In 2013, under the Affordable Care Act, the US created the Open Payments database to collect those reports from across the country.

For the new study, the researchers analysed 2011 data from Massachusetts payment reports and the prescription drug program of Medicare, the US public health insurance programme for the elderly and disabled. Of the 2,444 Massachusetts doctors in Medicare’s prescribing database, about 37% received payments from the drug industry; about 71% of doctors reported receiving meals paid for by drug companies; about 51% reported receiving grants; about 27% received other services; and about 11% reported receiving educational training.
Average payments to doctors ranged from $100 to $1,188, the researchers report.

Then the researchers looked at whether those payments were tied to doctors’ prescribing patterns. Specifically, they wanted to know whether doctors who received more gifts prescribed more brand-name cholesterol lowering drugs – known as statins – rather than less expensive generic medications.

Overall, an average of 17.8% of statin prescriptions were for brand name drugs. Every $1,000 of additional funds doctors received was tied to a 0.1% increase in the rate of brand name prescribing.

While a 0.1% increase may not seem like a lot, the researchers note that the financial effects for patients and the healthcare system can be substantial since brand name statins cost between two and four times more than generic medications.

There was no connection between brand name prescribing and industry payments when doctors received less than $2,000. “Not surprisingly, the payments that were categorised as educational trainings seemed to most impact brand name prescribing,” said Yeh.

The researchers say their findings are limited by the fact that doctors who prescribe a high number of brand name medications may be sought out by drug companies to promote those products. Also, the findings are based on self reporting by doctors.

Importance: Pharmaceutical industry payments to physicians may affect prescribing practices and increase costs if more expensive medications are prescribed.
Objective: Determine the association between industry payments to physicians and the prescribing of brand-name as compared with generic statins for lowering cholesterol.
Design, Setting, and Participants: Cross-sectional linkage of the Part D Medicare prescriptions claims data with the Massachusetts physicians payment database including all licensed Massachusetts physicians who wrote prescriptions for statins paid for under the Medicare drug benefit in 2011.
Main Outcomes and Measures: The exposure variable was a physician’s industry payments as listed in the Massachusetts database. The outcome was the physician’s rate of prescribing brand-name statins. We used linear regression to analyze the association between the intensity of physicians’ industry relationships (as measured by total payments) and their prescribing practices, as well as the effects of specific types of payments.
Results: Among the 2444 Massachusetts physicians in the Medicare prescribing database in 2011, 899 (36.8%) received industry payments. The most frequent payment was for company-sponsored meals (n = 639 [71.1%]). Statins accounted for 1 559 003 prescription claims; 356 807 (22.8%) were for brand-name drugs. For physicians with no industry payments listed, the median brand-name statin prescribing rate was 17.8% (95% CI, 17.2%-18.4%). For every $1000 in total payments received, the brand-name statin prescribing rate increased by 0.1% (95% CI, 0.06%-0.13%; P < .001). Payments for educational training were associated with a 4.8% increase in the rate of brand-name prescribing (P = .004); other forms of payments were not.
Conclusions and Relevance: Industry payments to physicians are associated with higher rates of prescribing brand-name statins. As the United States seeks to reign in the costs of prescription drugs and make them less expensive for patients, our findings are concerning.

Full Reuters Health report
JAMA Internal Medicine abstract

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