Doctors use more brands if they're on the pharma dole: JAMA

A new study offers more evidence that doctors who collect more payments from drugmakers prescribe more brand-name drugs.

Harvard Medical School researchers matched Part D Medicare claims in Massachusetts with data on pharma payments to Massachusetts physicians, zeroing in on prescriptions for statin drugs. The widely used class of cholesterol drugs is also widely available in generic form.

The conclusion? The higher the payments from drugmakers, the more prescribers used brands, rather than generics.

Overall, Massachusetts doctors prescribed branded statins 22.8% of the time. Doctors who collected no money from pharma prescribed brands at a rate of just 17.8%. Doctors who did saw their percentage of brand prescribing rise with every $1,000 in pharma payments reported, the JAMA Internal Medicine study said.

In an interview with ProPublica, the study’s lead author was careful to point out that the association doesn’t prove that the payments themselves are pushing doctors to prescribe more brands. Pharma could be targeting its payments to doctors who are already big brand prescribers, for instance, Dr. James S. Yeh told the publication.

Still, the results of the data analysis are worrisome, the authors concluded. 

“Industry payments to physicians are associated with higher rates of prescribing brand-name statins,” the study states. “As the United States seeks to [rein] in the costs of prescription drugs and make them less expensive for patients, our findings are concerning.”

The most common form of payment to doctors came in the form of pharma-sponsored meals. Pharma-funded educational programs were specifically associated with a 4.8% increase in brand prescribing.

The JAMA study follows ProPublica’s own, broader analysis of Medicare Part D data linked to doc payment information. The organization focused on all branded scripts issued nationwide by physicians in the 5 most common specialties. The findings: If doctors received money or gifts from drugmakers, even if just a free meal, they were more likely to use branded meds.

A 2013 study by the same organization dug more specifically into statin scripts, finding that higher payments from Pfizer ($PFE) were associated with higher numbers of scripts for that company’s statin drug Lipitor. Bigger payments from AstraZeneca ($AZN) correlated with bigger increases in its Crestor scripts, ProPublica found.

Doctors continue to dispute that payments from pharma would sway their prescribing decisions, but some high-profile scandals have suggested that some doctors definitely do. Medical schools have instituted “no-see” or “appointment-only” policies for affiliated physicians to quash worries that their doctors are influenced by interactions with drug reps, and other group practices have followed suit.

Drugmakers say they don't pick speakers based on their prescribing habits. The companies say they're simply educating doctors--and using physicians to educate other doctors--about new drugs, a valuable service for busy physicians amid big changes in the lineup of available treatments.

- check out the ProPublica coverage
- see the JAMA study

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