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Industry Payments to Physicians and Prescribing Brand-Name Statins in Massachusetts
Study Questions:
Is there a relationship between industry payments to physicians and the prescribing of brand-name as compared with generic statins for lowering cholesterol?
Methods:
Data were obtained by a cross-sectional linkage of the Part D Medicare prescriptions claims data with the Massachusetts pharmaceutical manufacturer physician payment database of Massachusetts physicians who wrote at least 50 prescriptions for statins in 2011. The exposure variable was a physician’s industry payments and the outcome was the physician’s rate of prescribing brand-name statins.
Results:
Among the 2,444 Massachusetts physicians, 899 (36.8%) received industry payments. The most frequent was for company-sponsored meals (n = 639 [71.1%]). Statins accounted for 1,559,003 prescription claims; 356,807 (22.8%) were for brand-name drugs. For physicians with no industry payments listed, the median brand-name statin prescribing rate was 17.8% (95% confidence interval [CI], 17.2%-18.4%). For every $1,000 in total payments received, the brand-name statin prescribing rate increased by 0.1% (95% CI, 0.06%-0.13%; p < 0.001). Payments for educational training were associated with a 4.8% increase in the rate of brand-name prescribing (p = 0.004); other forms of payments were not.
Conclusions:
Industry payments to physicians are associated with higher rates of prescribing brand-name statins. As the United States seeks to reign in the costs of prescription drugs and make them less expensive for patients, the findings are concerning.
Perspective:
With the exception of research grants and expert consultation that is highly regulated, many academic institutions do not allow any financial relationship with pharmaceutical industry representatives and proscribe stocking samples. While the practice has merit, this study suggests that providing meals (median value $187) for educational seminars during which specific brand and generic products are discussed is reasonable—particularly since the seminars are much better attended if lunch is provided. Two important points did not have adequate discussion. Atorvastatin became generic in late 2011, a time when many physicians felt there was an advantage of intensifying low-density lipoprotein cholesterol lowering with high-dose atorvastatin compared to moderately effective simvastatin, particularly in persons with established atherosclerotic disease, a fact that might have had more influence on the practice than the meal or speaker stipend. In fact, one could argue that the relationship with physicians and pharmaceutical industry representatives was relatively innocent and may have improved care considering the present lipid guidelines—particularly since the association between industry payments to physicians and brand-name prescribing had a threshold effect, which was limited to physicians who received $2,000 or more in 2011.
Keywords: Atherosclerosis, Cholesterol, Cholesterol, LDL, Drug Industry, Drugs, Generic, Dyslipidemias, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medicare Part D, Prescription Drugs, Simvastatin, Primary Prevention
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