You probably have seen them in your doctor’s office: Those really nice looking young people in a coat and tie, or a pretty pantsuit, carrying a spiffy briefcase and a bag filled with medicine samples.
They’re pharmaceutical reps. And a new study shows they probably wield just as much influence as the cynical among us always thought they did.
Published today in BMJ, researchers from Yale and the Center for Medicare Services have shown an association between payments to physicians for speaking and consulting fees, food and drink and other perks and written prescriptions for those companies’ drugs – at least when it comes to non-insulin diabetes meds and oral anticoagulants, both common among our booming elderly population.
The study was massive. Researchers examined 46 million Medicare Part D prescriptions written by more than 600,000 physicians to more than 10 million patients. They looked at more than 300 hospital referral regions.
“One additional payment in a region (median value $13) was associated with approximately 80 additional days filled of the marketed drug in the region,” the study concluded. “Payments to specialists and payments for speaking and consulting fees were associated with larger regional changes in prescribing than payments for non-specialists or payments for food and beverages or education.”
We all know what prescription drugs cost. That’s some serious bang for the buck.
Docs got $169 million for these two classes of drugs alone
Just how much money are we talking in terms of the dollars doled out to docs?
Nearly a million payments were given to the physicians in the 300-plus regions in 2013 and 2014. Just for the anti-coagulants, which are used to treat atrial fibrillation (A-fib) and other cardiovascular disorders, payments totaled more than $61 million. For the non-insulin diabetes drugs, approximately 1.8 million payments totaling more than $108 million were showered upon the docs.
How this study, the first of its kind, finally became possible is noteworthy as well. In a word: Obamacare.
“The Open Payments program, enacted as part of the Affordable Care Act, mandated manufacturers of pharmaceuticals and medical devices to report payments to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS). The resulting data include direct and indirect payments as well as payments in kind, such as the value of food and gifts, and details the manufacturers products associated with the payment.”
Previous studies have shown that doctors do not believe they are influenced by the payments.
Do you think your doctor is prescribing the best drug for you? Or is he or she possibly prescribing a more expensive drug that isn’t necessary, or even a drug that might not be as effective as something else? These are concerns I heard for more than two years as a reporter for Healthline News from patients with all sorts of medical conditions. I hope to someday write a long-form look at such practices as it pertains to HIV medications.
Authors admit study has limitations
The study does have limitations, the authors admit.
“Our findings do not necessarily suggest that payments by pharmaceutical manufacturers are harmful for patient care,” they wrote. “Patients may benefit from physicians being made aware of newly approved, effective treatments that may have fewer adverse effects, reduce the need for monitoring tests, or improve adherence. However, our findings support long voiced concerns about the potential influence of even small payments to physicians by pharmaceutical companies, such as for food and beverages.
“This influence on prescribing can potentially negatively affect patients through inappropriate prescribing, or more likely prescribing of more expensive, branded drugs when cheaper, generic alternatives exist. By one estimate, the geographic variance in high cost or low cost drug prescribing cost Medicare $4.5 billion in 2008.”
I always have said I really have no idea whether Obamacare is a good or a bad thing, because I’ve written about it so much I could see it either way. But I will say this: This sort of transparency is good for America any way it comes in our current climate of rampant political and corporate corruption.
“Our study has important limitations,” the authors go on to note. “Firstly, as the study was cross-sectional, we cannot prove the causality that marketing causes prescribing; it is possible that pharmaceutical companies market in regions where prescribing is already higher. Secondly, our results likely underestimate the association between payments by the manufacturers of pharmaceuticals and physician prescribing since we only had data on prescriptions filled, not prescribed, and our analyses were focused solely on Medicare Part D enrollees, who received approximately 25 percent of all the prescriptions written in the United States.”
The researchers report; you decide.