Physicians More Likely to Prescribe Brand Name Drugs After Payments from Manufacturers

Significant correlation found between physicians who accept industry money from pharmaceutical or medical device companies and brand name prescribing rates.

Although there has been little research on the relationship between pharmaceutical companies and physicians, recent analysis by ProPublica indicates that physicians who receive money from pharmaceutical companies are 2 to 3 times more likely to prescribe high rates of brand name drugs.

For the analysis, researchers combined Medicare Part D data with open payment data. Physicians who accepted industry money from pharmaceutical or medical device companies were identified as having received at least 1 cash, non-cash (in-kind), dividend, or stock payment from January to December 2014.

In order to account for specialties with different underlying rates of brand name prescribing, physicians with a p_brand of 1 standard deviation or more above the mean were considered “high brand name prescribers.”

To determine the differences in brand name prescribing rates between physicians given a high dollar amount of industry payments and physicians given low dollar payments, researchers compared the mean rates of both categories.

Physicians who received payments had a brand name prescribing rate 2% higher than those who did not receive payments, except in ophthalmology, which had a larger difference.

During the study, researchers only looked at physicians who received payments (n=111, 157), and compared the brand prescribing averages 5 ways using different dollar amounts as boundaries. The results of the study showed that physicians who received more than $5000 in total payments had a more significant difference.

Internists who did not receive payments had a brand name prescribing rate of 20%, compared with 30% among those who received more than $5000 in total payments.

“It again confirms the prevailing wisdom … that there is a relationship between payments and brand-name prescribing,” said associate professor of medicine at Harvard Medical School, Aaron Kesselheim. “This feeds into the ongoing conversation about the propriety of these sorts of relationships. Hopefully we’re getting past the point where people will say, ‘Oh, there’s no evidence that these relationships change physicians’ prescribing practices.’”

As far as prescribers that receive industry money, it seemed to greatly vary from state to state. The rate in Alabama, Kentucky, Nevada, and South Carolina were twice as high as Maine, Minnesota, Vermont, and Wisconsin.

However, overall the payments were widespread. Across the nation, almost 9 in 10 cardiologists who wrote a minimum of 1000 prescriptions received payments from drug companies in 2014. For internists and family practitioners, 7 in 10 received payments.

The payments within the analysis included: business travel, consulting, meals, speaking, and royalties and gifts, while researcher payments were not included.

“You can debate if these payments are good or bad, or neither, but what isn’t debatable is that they permeate the profession,” said analysis reviewer Walid Gellad.