Today’s Managing Health Care Costs Number is 50%
Propublica issued a new report late last week about the relationship between pharmaceutical payments to physicians and physician prescription of brand name medications for 17 months in 2013-14.
Spoiler alert –there is a strongly positive relationship. The physicians who receive the largest payments from the pharmaceutical industry are most likely to prescribe brand name medications. Among internists, physicians who get over $5,000 a year in pharma payments prescribe brand name drugs 50% more than physicians who receive no such payments.
Association is not causality. Some physicians have clinical interests or patient populations which are far more likely to require brand name medications , such as doctors who care for many HIV patients, or many patients with rheumatoid arthritis. The pharma companies might be more likely to ask these physicians to consult or to give talks because of their clinical area, rather than as a way of seeking to influence them. Reverse causality is possible.
The national database of pharma payments to physicians are imperfect, too. Some physicians were paid millions, or even tens of millions, in exchange for patents that came from their research. That’s a bit different from receiving $5000 for a 40 minute evening talk in a restaurant. The database includes every scrap of food that pharmas purchase on behalf of physicians, too. I’m in the database for accepting $14 for food in Marc, 2014. (The listed drug for this was “other.”) I have no idea what this was from. Note that I wrote less than 1000 Medicare Part D prescriptions, so there is no public reporting of my generic prescription rate.
A few observations from reading this article and looking at the database.
1. Drug company payments to physicians are close to ubiquitous. Doctors in many states were close to 100% likely to receive drug company payments.
2. Influential physicians who are receiving tens of thousands of dollars a year are also often members of specialty society committees making recommendations for evidence based treatment. See for instance the endocrinologist who had the largest number of drug company payments during this time period. He’s also a coauthor of the American Academy of Clinical Endocrinology’s guidelines. His most recent article is entitled “Biosimilars are not Generics.”
3. Sunshine is a great disinfectant. I believe that collecting this data and making it public will lead to public discussions of the relationship between pharmaceutical company payments and drug prescribing – and that discussion can lead to improved and more cost effective care for patients.
4. Big data rocks! Reviewing every prescription is infeasible, and in individual cases using a brand name drug is often the right answer. Big data has allowed Propublica to determine average rate of generic prescription by specialty and state – and when one physician has a brand prescribing rate around the state average of 20% and another is closer to 40% - it’s worth looking harder.
I’m hopeful that physicians will look at their own reporting on the Propublica app. We often don’t know how we compare to our peers –and perhaps those physicians who prescribe more brand name drugs than their peers will reevaluate their prescribing habits.
