Perks for doctors are a pharmaceutical industry staple, with sales reps handing out everything from branded notepads to a free lunch. Now a troubling study suggests that when doctors receive perks such as a meal they are more likely to prescribe expensive brand-name drugs instead of their generic alternatives.
The study comes from Adams Dudley, MD, and other researchers at the Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco (UCSF). The researchers published their study June 20th in the Journal of the American Medical Association (JAMA) Internal Medicine. They hoped to determine what effect perks from pharmaceutical companies to physicians had on which drugs the doctors prescribe, which in turn may affect the cost of prescription drugs.
To look into the effect of perks on prescribing behavior, the researchers looked at Medicare claims data for statin prescriptions in 2011 as well as payments to 2,444 licensed physicians in the state of Massachusetts who wrote these prescriptions. The researchers analyzed the data to see if there was a link between pharmaceutical industry payments to the physicians and which drugs they prescribed.
The researchers that discovered that 36.8 percent of the Massachusetts physicians in the database received payments from the pharmaceutical industry, most commonly pharmaceutical company-sponsored meals at 71.1 percent. The study authors also found that of the 1,559,003 claims for statin prescriptions, 22.8 percent of those prescriptions were for brand-name drugs instead of their generic equivalents.
When the researchers divided doctors who received industry payments from those who did not, they found that the doctors who had no industry payments prescribed brand-name statins less frequently, at 17.8 percent. Doctors who did reveal industry payments tended to prescribe brand-name statins 0.1 percent more for every $1,000 in payments. When the payments were associated with educational training, the doctors prescribed brand-name drugs 4.8 percent more frequently.
The researchers found that when doctors received a meal from a Crestor sales representative four or more times, they were 1.8 times more likely to prescribe this brand-name statin compared to brand-name alternatives like Lipitor. There is also a generic version of Lipitor, which although cheaper, works similarly to other statin drugs for lowering cholesterol.
Another example drug, Bystolic, treats high blood pressure and is in a class of drugs called beta blockers. Although other beta blocker drugs may be available, doctors who received at least one meal related to Bystolic were twice as likely to prescribe that particular brand versus doctors who did not receive any perks.
Although the researchers could not determine whether the free meals and other perks caused the doctors to prescribe brand-name drugs more often, the statistics do seem to suggest that as payments to doctors increase, those doctors are prescribing those brands more. The study does not provide insight into why doctors may prescribe brands more when they receive perks, or if they are even aware that they are doing it. When sales representatives have lunch with a doctor, they may be spending less than $20 on a meal on average, but they do gain time to discuss their product with the doctor and promote its benefits. Doctors may also feel obligated to listen to what a sales representative has to say when they have received a gift. The pharmaceutical companies emphasize that their representatives meet with doctors to share important information about the drug, such as safety, new approved uses for the drug, and possible side effects, and point out that all perks are revealed publicly. Although the doctors may not be receiving huge financial rewards for prescribing a particular company’s drug, the small perks do seem to be influencing which drugs the doctors do prescribe, according to this study.
The possible link between perks for doctors and their prescribing behavior is troubling. Other studies have linked high drug costs with lack of medication compliance in seniors and others who are struggling financially. If someone simply cannot afford an expensive drug, they may not take it, putting their health at risk. Others may be paying for their medication by making cuts in other areas, such as buying healthy groceries. Even for those who are insured, prescriptions for expensive brand-name drugs may be pushing them towards their claim limit and driving up the cost of their insurance overall. Anything that may be driving doctors to prescribe more brand-name drugs instead of cheaper, generic alternatives could be helping to make prescription drugs less affordable.