1 Possible Side Effects: Investigating the Connection Between Payments from Pharmaceutical Companies and the Prescribing Patterns of Physicians March 15, 2018
Table of Contents 2 I. Study Objective and Executive Summary II. Rising Drug Costs III. Analysis IV. Study Results V. Largest Payers VI. Opioid Results VII. Physician Payments by Specialty VIII. Additional Resources
I. CareDash uses newly available Medicare Part D data and demonstrated correlations between payments to physicians and prescribing patterns Executive Summary • This study examines the correlation between payments to physicians for specific drugs and prescription habits for those drugs using newly available prescription level data from the Centers for Medicare and Medicaid Services • Our study identifies a strong financial relationship between pharmaceutical marketing tactics and physician prescribing habits • Correlations in this study indicate the likelihood that when doctors are paid for services such as speaking engagements, consulting, etc., on behalf of a brand-name drug, they will prescribe that drug over a generic, or other brand-name alternatives • No previous study has done this across all providers and drugs • The study found that physicians receiving a payment from a pharmaceutical for specific branded drug were 5x more likely to be high prescribers of that drug • Shockingly, this increased to nearly 14.5x for branded opioid drugs • Variations can be seen by physician specialty type ranging from around 3x more likely for cardiologists to 7x more likely for family medicine When doctors received a payment for services such as speaking engagements and consulting, etc. on behalf of a brand-name drug, do they prescribe that drug over generic or other brand-name alternatives?
II. Prescription drug costs are a massive contributor to our rising healthcare costs, driven by branded drugs Rising Drug Costs (2007-2016) 500 • Invoice spending on medicines was 450 $450B in 2016, expected to rise to 400 $580B - $610B by 2021 350 Spending (Billions) 300 • Brand-name drugs account for 72% of 250 all costs despite being just 10% of 200 prescriptions 150 • For many brand-name drugs, generic 100 equivalents exist at greatly reduced 50 prices 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year Net Spending Invoice to Net Difference Source: QuintilesIMS, National Sales Perspective, Dec 2016; QuintilesIMS Institute
III. Our analysis joins payments to doctors with newly available Medicare prescriptions data to create a fresh look at the impact of payments on prescribing patterns Representative Payments Data Sample Physician Profile ID Manufacturer or GPO Name Total Payment Amount (USD) Nature of Payment Drug Name Program Year Koven Technology, Inc. $107.40 Royalty or License Smartdop XT Vascular 2014 349191 FERA PHARMACEUTICALS, LLC $250.00 Consulting Fee Moxatag 2014 349191 $6.2B total, payments to individuals range from $0 to $58.4M Representative Medicare Prescription Data Sample NPI Last Name First Name Drug Name Generic Name Beneficiaries Total Claims ELAM ISAAC HYDROCODONE-ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN 45 200 1497998215 GREENBERG ALEX VICODIN HYDROCODONE/ACETAMINOPHEN 12 14 1811052285 Data contains over 800M prescriptions
IV. Providers receiving payments on behalf of a drug are around 5x more likely to choose that drug over its alternatives Impact of Payments on Prescription Patterns 2015 Payments occurring prior to Payments as Payments occurring after prescriptions in same year prescriptions prescriptions 2014 2015 2016 5.25x 5.0x 5.48x more likely to receive more likely to prescribe more likely to prescribe payment from drug drug next year after drug if receiving payment company after prescribing receiving payment the same year in previous year previous year
V. Three companies gave over $100M to physicians from 2014 to 2016 Top Pharmaceutical Payments by Company Top Payment Categories 2014-2016 Company Payments Reported Key Drugs • Royalty or license: $2.8B • Xarelto $197.6M • Invokana • Promotional speaking or service: $1.7B • Consulting: $1.2B • Crestor $167.3M • Symbicort • Botox $136.5M • Vraylar
V. There was $185M in payments to physicians for just Xarelto, Invokana and Humira from 2014 to 2016 Top Payments by Drug (2014 to 2016) Company Payments Reported Company $76.5M Janssen $55.9M Janssen $53.0M Abbvie
VI. Physicians are 14.5x more likely to choose a specific opioid drug when receiving payments Top Branded Opioid Payments (2014-2016) Company Payments Reported Key Drugs $16.0M • Subsys (Fentanyl) • Oxycontin $11.5M • Hysingla ER $5.7M • Nucynta From 2014 to 2016, there were $43M in payments to physicians directly associated with branded opioid drugs
VI. The study showed variations in the correlations between payments and prescribing patterns across specialties Increase in Likelihood of Prescription Correlations by Specialty by Specialty Type (2014-16) • The study also examined Year of Payments correlations by physician Specialty specialty 2014 2015 2016 • For example, Family Practice Family Practice 5.95 5.57 6.99 physicians were 7 times more likely to receive a payment in Internal Medicine 4.7 4.27 4.93 2016 after being high Psychiatry 3.88 3.85 4.34 prescribers of a drug in 2015 Cardiology 3.28 2.8 3.35
VII. Additional Resources For more information on “Possible Side Effects: Investigating the Connection Between Payments from Pharmaceutical Companies and the Prescribing Habits of Physicians” please visit: www.caredash.com/openpayments
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