Abstract
BackgroundWhile many new medications may offer advantages over existing drugs, some newer drugs are reformulations of existing products that provide little innovation or incremental benefit while driving up drug costs. Despite the lack of benefit of these medications, prescribers may be motivated by payments made by the pharmaceutical industry. The objective of the study was to determine the association between payments made to physicians by the pharmaceutical industry and prescriptions for certain selected costly brand name drugs.MethodsThis was a cross-sectional, retrospective study linking the Open Payments Database and Medicare Part D Prescriber Public Use File for 2014, including 667,278 physicians who prescribed one of 6 brand-name drugs with less costly but similarly effective alternatives: lovastatin ER, almotriptan, amlodipine+olmesartan, ibuprofen+famotidine, saxagliptin+metformin and naproxen+esomeprazole. The primary outcome was the odds of a physician prescribing one of the selected drugs, and the primary predictor was the receipt of any payment from the pharmaceutical industry.ResultsThe odds of prescribing 3 of the 6 drugs were increased among physicians who received industry payment, compared to those without payment: amlodipine+olmesartan, aOR 1.42, (95% CI 1.36–1.49); saxagliptin+metformin, aOR 1.50, (95% CI 1.42–1.59); and naproxen+esomeprazole, aOR 1.45, (95% CI 1.25–1.68). Payment from the manufacturer of the specific drug, compared to not receiving payment from the drug’s manufacturer, was associated with increased odds of prescribing 4 of the 6 drugs: amlodipine+olmesartan, aOR 2.40, (95% CI 2.29–2.52), ibuprofen+famotidine, aOR 8.06, (95% CI 5.42–12.00), saxagliptin+metformin, aOR 2.21, (95% CI 2.10–2.34) and naproxen+esomeprazole, aOR 5.96, (95% CI 5.08–7.00).ConclusionsA physician-industry financial relationship was associated with increased odds of prescribing costly brand-name drugs of uncertain medical benefit. Patients, as healthcare consumers, should demand transparency from their physicians about payment from the pharmaceutical industry to increase shared decision-making. Physician and policy makers need increased awareness and reflection on how industry payment influences their prescribing practices.
Highlights
While many new medications may offer advantages over existing drugs, some newer drugs are reformulations of existing products that provide little innovation or incremental benefit while driving up drug costs
AAdjusted for gender, specialty, region, therapeutic category and overall prescribing volume bEach drug was analyzed in a separate model p-value
Our study adds to the accumulating evidence of the influence of pharmaceutical industry payments on the use of newer, expensive brand name medications that have effective, less costly alternatives
Summary
While many new medications may offer advantages over existing drugs, some newer drugs are reformulations of existing products that provide little innovation or incremental benefit while driving up drug costs. Despite the lack of benefit of these medications, prescribers may be motivated by payments made by the pharmaceutical industry. The objective of the study was to determine the association between payments made to physicians by the pharmaceutical industry and prescriptions for certain selected costly brand name drugs. Prescription costs in the U.S are the highest in the world [1] These high costs have been attributed to the complex drug development process and to the restriction of price negotiation and government-protected monopolies granted to drug manufacturers [2]. Pharmaceutical manufacturers practice many methods to innovate and maintain market shares, including reformulating existing molecules and combining drugs [3]. While many new brand name drugs have clear medical benefits over alternatives already on the market, some do not, especially when considering the lower costs of existing alternatives. With tolerance being the only clear benefit of the combined formulation, the listed wholesale acquisition cost (WAC) of $2259 for a bottle for 60 tablets may be hard to justify compared to the WAC of 60 tablets of naproxen ($6.36) and 60 tablets of esomeprazole ($225) [4]
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