Back in the early years of managed care, the industry was constantly assaulted for putting money ahead of patient’s health needs. At the same time it was presumed that providers, especially physicians, were somehow not subject to the same economic incentives and motivations as the rest of the world. I think that notion has been pretty well disproven by now, and a new analysis from ProPublica suggests that physicians, among other things, are susceptible to changing their treatment decisions based on cash or other benefits they get from pharmaceutical manufacturers. (ProPublica Analysis) The authors used “Sunshine Act” payment data from 2014 and matched it with drug prescribing records from Medicare’s Part D coverage.
The headline finding is that doctors who took industry payments were much more likely to prescribe more brand-name drugs. For example, internists who received no benefits had an average brand-name prescribing rate of 20%, while those who received $5000 or more in benefits had a rate of 30%. Taking payments or some benefits is fairly common, 90% of cardiologists who wrote a 1000 or more prescriptions for Medicare beneficiaries took some form of payment from a medication company, as did 70% of internists and family practice doctors. There is a fair amount of geographic variation among physicians in accepting these payments; Nevada, Alabama, Kentucky and South Carolina had twice the rate as that in Vermont, Minnesota, Wisconsin and Maine.
Some doctors try to justify use of brand-name drugs based on quality, but that is pure BS. Now, it is possible that doctors who prescribe more branded drugs are just more inclined to be willing to accept medication manufacturer cash; that the causation or correlation is in reverse of what it seems to be. The rationale would be “I’m going to prescribe these drugs anyway so I might as well take the manufacturer goodies.” I don’t think that is likely in a world where there is very high awareness of the problem of expensive brand-name drugs and the lack of effectiveness of many of them for significant segments of patients. PBMs and health plans tend to be pretty vigilant about inappropriate use. So the most likely explanation is that doctors are just like the rest of us–do something nice for them and they are more likely to do something nice for you. And drug companies certainly understand how that works.