How Big Pharma Pays Practitioners to Prescribe Higher Cost Treatments

When The Media Says "Experts" They Mean Paid Corporate Shills (Part 30)

Paxlovid’s recent flop in a RCT, published in the New England Journal of Medicine, which found that it reduced the median time to sustained alleviation of all signs and symptoms by only one day less than the placebo group, has reminded me of this ProPublica analysis of the positive relationship between total drug company payments to doctors and the volume of prescriptions written for their drugs that they conducted in 2019 when Purdue Pharma’s marketing fraud was still fresh in the public consciousness and it was still politically correct to point out the Pharmaceutical industries corruption of the medical profession. The analysis, which compared the pattern of payments from Pharma companies to individual doctors documented in the open payments system database, which you can find at (https://openpaymentsdata.cms.gov/), and the pattern of prescriptions those doctors wrote for the 50 most prescribed brand drugs for Medicare Part D beneficiaries, found that doctors who received payments from the drugmaker of one of the 50 top brand name prescriptions prescribed their drugs 58% more often, on average, than doctors who did not receive payments from the drugmaker for 46 of the top 50 prescribed drugs. While this is not conclusive proof that Pharma payments change doctor’s behavior, it is evidence that financial compensation from industry to practitioners produces tangible results that are profitable for the former generating millions in additional revenue from thousands of dollars in additional expenses. A concurrent HHS report at the time found that doctors’ who prescribed brand name drugs over the same generic drug cost beneficiaries and the program $3 billion more. The industry paid doctors $137 million for activities related to the top 50 drugs prescribed to Medicare part D beneficiaries (e.g. food, beverage, lodging expenses to attend conferences, promotional speeches, dinners and lunches paid for by reps etc.). The data shows that brand drugmakers pay doctors who prescribe their drug at least 11 times more than doctors who prescribed their drug fewer than 11 times as the former was paid an average of $100 dollars more. Using a regression model that excluded doctors with fewer than 11 medicare claims for any specific drug and doctors who made at least 11 medicare claims for any drug but received zero industry payments, they found that any industry payment to a doctor was associated with a 30% increase in prescriptions they wrote for a particular drug or an additional 10 medicare claims. An earlier analysis conducted in 2016 using 2014 Medicare Part D database and Open Payments data and excluding doctors with fewer than 1,000 overall medicare claims found that doctors who received payments from brand drugmakers were 2-3x more likely to prescribe brand name drugs than doctors who did not receive payments and doctors who were paid for promotional speeches had higher rates of brand drug prescribing than doctors who only received other types of payments such as reimbursement for travel expenses or lunches/dinners. Even doctors who only received free meals prescribed brand drugs at slightly higher rates than doctors who received no payments which is evidence that even small gifts could change behavior and create another disadvantage for generic drugs.