The Relationship of Industry Payments to Prescribing Behavior: A Study of Degarelix and Denosumab

Abstract

IntroductionThe influence of financial ties to pharmaceutical companies remains controversial. We assessed a potential relationship between pharmaceutical payments and prescription patterns for degarelix and denosumab. MethodsWe compared Medicare Provider Utilization and Payment Data: Physician and Other Supplier PUF (Public Use File) (Medicare B) data containing 2012 claims with data on Open Payments (Physician Payments Sunshine Act) for the second half of 2013. Urologists and medical oncologists who billed Medicare for degarelix or denosumab were cross referenced in both databases and payments were aggregated into a consolidated data set. Adjusted beneficiary count and total Medicare reimbursement were compared according to the receipt of Sunshine payment. An association between Sunshine payment amount and total Medicare reimbursement was also assessed. ResultsOf the 160 prescribers of degarelix and 1,507 prescribers of denosumab 91 (57%) and 854 (57%), respectively, received Sunshine payment. Degarelix prescribers who received Sunshine payment had higher median total Medicare reimbursement ($13,257 vs $9,554, p = 0.01). Denosumab prescribers who received Sunshine payment had higher median adjusted beneficiary count (55 vs 50, p <0.001) and median total Medicare reimbursement ($69,620 vs $60,732, p <0.001). On multivariable analysis receipt of Sunshine payment (adjusted median difference $5,844, 95% CI 937–10,749) and oncology specialty (adjusted median difference $34,380, 95% CI 26,715–42,045) were independently associated with total Medicare reimbursement for denosumab. ConclusionsIn the case of degarelix and denosumab there is a weak association between pharmaceutical company payments and prescriber prescription behavior patterns.