Study Confirms Link Between Overprescribing and Big Pharma Payments

US doctors who receive direct payments from opioid manufacturers tend to prescribe more opioids than doctors who receive no such payments.

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These types of incentives may make physicians consciously or unconsciously more inclined to prescribe a particular brand of drug, or prescribe it in greater quantities.

Money talks, and doctors are saying “yes” to strategic payments from pharmaceutical companies. New research published by Addiction found that US doctors who receive direct payments from opioid manufacturers tend to prescribe more opioids than doctors who receive no such payments.

Lead researcher Dr. Thuy Nguyen of Indiana University’s School of Public and Environmental Affairs said, “Put simply, drug-related payments to physicians seem to increase drug prescriptions, and higher payments seem to increase them more.”

A “direct payment” to a doctor can mean a few different things. Pharmaceutical companies can’t pay doctors to prescribe their drugs because that is illegal. A pharmaceutical company can’t give a doctor a check and say, “We will pay you $50,000 this month to write 100 prescriptions for our product.” However, the companies can pay doctors to talk about particular drugs at speaking engagements. They can also pay doctors for consulting work and conference attendance. Pharmaceutical companies can also send ‘detailers’ (salespeople) to doctors’ offices to promote their drugs, possibly paying for a meal or leaving drug samples behind.

Although it’s not the same as handing over a check, pharmaceutical companies’ incentives are convincing. The new study shows that they are persuasive marketing and they’re causing doctors to increase the number of prescriptions they write. According to Eureka Alert, these types of incentives may make physicians consciously or unconsciously more inclined to prescribe a particular brand of drug, or prescribe it in greater quantities.

The report found that the association between payments and prescribing is strongest for hydrocodone and oxycodone, the most frequently prescribed opioids among Medicare patients, which is Americans of 65+ years and some younger people with disabilities. The Medicare population is estimated to have the highest and fastest growing prevalence of opioid use disorder in the US. The study looked at the prescribing practices of 63,062 US physicians who directly received opioid-related promotional payments, compared with over 802,000 physicians who received no such payments. From 2014 to 2016, the doctors who received payments prescribed, on average, over 13,070 daily doses of opioids per year more than their unpaid colleagues.

The data sets for the study came from publicly available sources on data.cms.gov, a website maintained by the Centers for Medicare and Medicaid Services (CMS). The data on direct payments to physicians came from the Open Payments website, which publishes data reported under the Physician Payments Sunshine Act (PPSA), the US healthcare law that requires medical product manufacturers to disclose payments and other transfers of value to physicians. The researchers also used the Medicare Part D Prescriber Public Use File, which holds data on prescriptions provided to and filled by Medicare beneficiaries.

As more Americans are aware of the national drug epidemic and concerned about opioid use disorder and ethical prescribing, it is important to acknowledge the role that pharmaceutical companies’ marketing play. In influencing doctors and providers, these companies’ direct payments also affect patients, their families, and their communities.

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