Another year of Sunshine Act data means another year's worth of dollar figures showing industry watchers just which drug brands are shelling out the most on payments to doctors. Once again, most of the meds at the top of the list aren’t cures—but they are products facing of plenty of competition.
ProPublica has updated its Dollars for Docs database, which tracks just how much pharma and med device companies spend on “general payments”—for promotional speaking or consulting, but not research—in the form of money, meals, travel, gifts and royalties.
The top-spending brand in 2015? Johnson & Johnson anticoagulant Xarelto, with $28.4 million shelled out to healthcare providers. Behind it was AbbVie behemoth Humira at $24.9 million, and rounding out the top 5 were Johnson & Johnson SGLT2 diabetes med Invokana with $20.9 million, hep C combo Viekira Pak from AbbVie at $19.2 million, and Xarelto foe Eliquis—made by Pfizer and Bristol-Myers Squibb—at $18.8 million.
If there’s one thing those brands have in common, it’s serious competitive threats. Xarelto has watched slow-starter Eliquis zoom up behind it in the next-generation blood-thinner battle, but Eliquis has yet to overtake the heavyweight even with a stepped-up promotional budget.
Humira, meanwhile, is under siege by new-age psoriasis meds, and its first biosimilar challenger—Amjevita, from Amgen—already has FDA approval. AbbVie is waging a legal battle to protect its superstar, but it’s unclear it’ll be able to hang onto top dog status.
As for Invokana? It faces a pair of nemeses in the SGLT2 group, one of which—Eli Lilly and Boehringer Ingelheim’s Jardiance—last year became the first diabetes med to show it could improve cardiovascular outcomes for high-risk patients. That med this month won a label expansion from the FDA clearing reps to promote its ability to cut down on the risk of CV death.
And Viekira’s battle for hep C market share has been well-documented. Its arrival—and AbbVie’s exclusive contract with PBM Express Scripts—made waves on the drug pricing front, where rival Gilead had raised some red flags with its pricey Sovaldi and Harvoni. But Viekira still hasn’t measured up to expectations, and now it has further competition from Merck’s Zepatier, too.
Will forking over millions in gifts and speaking fees actually influence prescribing behavior, though? Some companies and outspoken docs have insisted it won’t, although ProPublica’s research suggests otherwise.
Combining previous payment data with prescribing data from the federal Medicare program, its investigators showed in March that physicians who take pharma handouts tend to prescribe more branded meds than those who don’t.
Meanwhile, pharma’s overall doc-payment spending didn’t change much between 2014 and 2015, ProPublica says. Companies made about $2 billion in general payments to 618,000 physicians in each of those years, and that’s not counting $600 million a year they paid to teaching hospitals.