According to research reported earlier this summer by ProPublica, top prescribers of a drug (under Medicare Part D) frequently receive payments from the that drug’s manufacturers, sometimes a lot of money.
For example, 17 of the 20 doctors who prescribed the high blood pressure drug Bystolic most frequently (approximately 530 prescriptions each) were also paid a combined $283,450 by Forest Pharmaceuticals (Bystolic’s manufacturer) to give speeches about the drug to their peers in 2010.
Although some drug companies state that they don’t choose speakers based on whether they prescribe their products, the ProPublica analysis shows that doctors who do prescribe such medications often receive significant amounts of money from manufacturers– more than $16,000 each, on average. Given that Forest Pharmaceutical’s earnings on Bystolic doubled to $348 million last year, compared to its sales in 2010, it appears this marketing tactic is helping the company generate a hefty return on investment.
Overall, ProPublica found the practice of paying doctors who are high-volume prescribers of a manufacturer’s products to be widespread across many drug and device manufacturers. ProPublica reported that 9 out of the top 10 prescribers of Exelon (to treat Alzheimer’s) received funding from the drug’s manufacturer, Novartis. Similarly, 7 of the top 10 prescribers of Advair Dsikus (an asthma medication) received funding from the manufacturer, GlaxoSmithKline, with one doctor receiving more than $100,000 between 2009 and 2012.
Higher prescription rates of these brand name drugs results in higher costs for consumers and their health plans. Many of the brand-name drugs promoted by manufacturers may be no more effective than other less costly drugs, including generics. In the case of Bystolic, there is no evidence the drug is any more effective than other drugs on the market that treat high blood pressure, according to ProPublica. But the brand name drug Bystolic costs $80 per month, while generic alternatives only cost $10.
Efforts are being made to crack down on drug companies’ influence on doctors’ prescribing practices. In recent years, law suits regarding illegal marketing practices that include inappropriate payments to doctors have been brought against many drug companies, including Forest and Novartis, leading to settlements, and requirements that the manufacturer publicly disclose some or all payments to doctors.
Thanks to the advocacy of many organizations and champions in Congress, the Physician Payment Sunshine Act became law in 2009, and went into effect this month. As of August 1, all drug companies are required to track and report payments to physicians and teaching hospitals. This data will be available to the public beginning September, 2014. Once the data is released, better, more comprehensive analysis of prescribing patterns and company payments to doctors will be possible.
Some doctors may fear that this transparency could make patients unduly suspicious of their prescribing of a certain drug. In fact studies have shown that knowing your doctor has financial connections with a drug company can make a patient less likely to trust their doctor’s prescribing decisions.
But other doctors think the transparency will help build patient trust. Dr. Steve Nissen of the Cleveland Clinic told ProPublica, “I don’t want the patient…to have to worry about whether I am prescribing a drug because I am being paid by the company that makes the drug.”
We agree. And we believe the release of drug and device industry payments to doctors will empower patients.
While transparency is vital to informing and empowering consumers, conversation between doctors and patients about a patient’s ability to afford their medication also must take place. Sadly, these conversations are not happening as often as they need to, leaving patient struggling to afford their medications. Ultimately, patients along with unbiased doctors, and not drug companies, must have the most influence over the drug a doctor prescribes, and the patient buys.
-- Wells Wilkinson, Staff Attorney, Community Catalyst -- Maggie Sheets, Program Associate, Community Catalyst