Brand name medications are usually more expensive than generic drugs, and patients trust that doctors have good reason to prescribe a brand name over a generic drug. But a recent study has found that gifts and payments from pharmaceutical companies have a noticeable impact on which drugs doctors prescribe, and inflate the number of brand name prescriptions.
The Affordable Care Act, passed in 2013, created the “Open Payments” database that publicly records all gifts drug and device companies give to doctors. Gifts can include stocks, money for research, speaking fees, meals, along with other payments. The database is designed to bring transparency to an opaque corner of medicine and shed light on the impact these gifts have on doctors' decisions.
Though doctors are required to participate in the database, it relies on the doctor's own self-reporting, which could be flawed.
James Yeh along with associates at the Women's Hospital in Boston studied the database's information from 2011 for statins (heart medicines) prescribed by doctors. They found that there was a small, but noticeable, link between gifts from drug and device companies and subsequent prescriptions and uses of those companies' products.
For every $1,000 in gifts received by doctors by a brand name company, the use of the brand name drug or device increased by 0.1%. Brand name companies that paid for educational training of doctors saw a 4.8% increase in the use of their products.
The researchers found that individual company-backed payments ranged from $100 to $1,188.
0.1% and 4.8% sound like small numbers, but they can have big effects when multiplied over the nation's entire health care system. For example, generic statins can cost a patient about $12 a month, while brand-name statins can cost around $500 a month.
Fox News Health dug into the database and researched the pharmaceutical companies that contributed the most money to doctors in 2014. The top contributors along with the amount contributed were:
- Tyvaso (high blood pressure medication), $59,095,500
- Bydureon (diabetes medication), $22,721,700
- Invokana (diabetes medication), $19,765,700
- Xarelto (anticoagulant), $18,299,300
- Eliquis ( anticoagulant), $18,092,100
Another recent study by Pro Publica also confirmed the link between pharmaceutical gifts and name-brand prescriptions. The study found that doctors who received over $5,000 in gifts were 10% more likely to prescribe a name brand drug over all other doctors.
The study found that brand name prescribing can be traced to certain specialties; some specialties of doctors reward gifts from companies more than other specialties. Of the Opthalmologists in the study that received $5,000 or more in gifts from companies, 64% prescribed a brand name drug. Of the other doctors that received over $5,000 in gifts, 30% of internal medicine doctors prescribed name brands, as did 25% of family medicine doctors , 24% of cardiovascular disease doctors, and 18% of psychiatrists.
Visit the Dollars for Docs website to learn more about the influence of money in doctor's prescriptions.
Some in the health care industry argue that links between gifts and prescriptions are not always bad; doctors may get the chance to learn about a new and better drug. Some also say that there are flaws in the ways the studies defined “gifts” that made normal payments have bad connotations.
Still these studies confirm that the link exists, and some patients are paying thousands of dollars a year for name brand drugs with questionable benefits.