Pharmaceutical industry payments may influence branded statin prescriptions

Physicians in Massachusetts who received payments from the pharmaceuticals industry had higher rates of prescribing branded statins compared with doctors who received no payments, according to a cross-sectional study.

Lead researcher James S. Yeh, MD, MPH, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues published their findings online in JAMA Internal Medicine on May 9.

“As the United States seeks to rein in the costs of prescription drugs and make them less expensive for patients, our findings are a cause for concern,” the researchers wrote. “We found that pharmaceutical industry payments to physicians were associated with higher rates of prescribing brand-name statins. On average, a $1000 increase in total payments was associated with a 0.1% increase in the percentage of brand-name prescriptions.”

The researchers analyzed information from the Medicare Part D prescription claims database and the Massachusetts physician open payment database. The Medicare Part D data became publicly available after ProPublica requested the information through a Freedom of Information Act. The Massachusetts Department of Health compiled the payment database. 

They evaluated data on 2,444 Massachusetts physicians who prescribed statins from January 1 to Dec. 31, 2011. The analysis included the following statins or statin-containing products: niacin, extended-release and lovastatin (Advicor); lovastatin, extended-release (Altoprev); amlodipine-atorvastatin (Caduet); rosuvastatin (Crestor); sitagliptin-simvastatin (Juvisync); fluvastatin (Lescol); fluvastatin, extended-release (Lescol XL); atorvastatin (Lipitor); ezetimibe-atorvastatin (Liptruzet); pitavastatin (Livalo); lovastatin (Mevacor); pravastatin (Pravachol); niacin, extended-release and simvastatin (Simcor); ezetimibe-simvastatin (Vytorin); and simvastatin (Zocor).

Of the physicians, 36.8 percent disclosed a financial relationship with pharmaceutical manufacturers in 2011. The researchers found that 71.1 percent of physicians received a company-sponsored meal, 50.9 percent received a grant, 26.3 percent received payment for bona fide services and 10.6 percent received educational training. They defined bona fide services as “an arrangement for services including, but not limited to, research, participation on advisory boards, collaboration with 501(c)(3) organizations dedicated to the promotion of health and the prevention of disease, and presentations at pharmaceutical or medical device manufacturing company-sponsored medical education and training.”

The median total financial payment was $260, while the median value of payments attributed to meals was $187, the median value of grants was $100, the median value of consulting and speaking bureaus was $3,001 and the median value of educational training was $345.

Of the more than 1.5 million statin prescriptions, 22.8 percent were for branded medications. Physicians who received no industry payments prescribed branded statins 17.8 percent of the time. Atorvastatin accounted for 75.4 percent of the branded statins, while simvastatin accounted for 85.4 percent of generic statins.

Physicians who received payments for educational training had a 4.8 percent increased in branded prescribing compared with physicians who received no educational training. However, payment for food, consulting and speaker bureaus and grants were not associated with a higher rate of brand-name prescribing.

The study had a few limitations, according to the researchers, including that the database only had claims on prescriptions that were filled, which may have underestimated the prescriptions. They cited previous research that found prescriptions for branded drugs were less likely to be filled because they are more expensive than generic drugs.

The researchers added that the design allowed them to only detect an association between brand-name prescribing and physicians receiving payments from pharmaceutical companies.

“It is possible that the physicians who more frequently prescribed brand-name pharmaceuticals were also those who were more open to receiving industry funding for meals, conferences, or other purposes,” they wrote. “Alternatively, high prescribers of brand-name drugs may have been sought after by pharmaceutical companies to promote their products through various marketing activities, such as participation in speakers’ bureaus.”

In addition, they said there was no way to ensure the reports of industry payments were complete and accurate.

“For example, companies may choose to report certain payments to physicians as bona fide services, a catch-all payment category that might cover payments for marketing-related consulting, participating in speakers bureaus, and research. In addition, payments for education might be reported under several payment categories, such as grants/educational gifts, and educational training. We were unable to determine the frequency of misattribution of the payment category or underreporting of payments. Nor were we able to control for certain physician characteristics not found in either database (eg, practice characteristics, level of experience) that may have an impact on prescribing patterns. We could not determine which physicians received payments from a specific company and analyze their prescribing of that company’s products.”