Here is another reason that US taxpayers may want to know why some doctors prescribe some drugs. Medicare Part D, as you know, helps cover the cost of many medicines for many people. But what if a physician is paid speaking or consulting fees by a drugmaker and then prescribes its medicine, even if there is no added benefit compared with cheaper alternatives? This could raise the bill for taxpayers.
This sort of inflated expense is a side effect of what some call extreme prescribing – a trend in which some physicians write prescriptions for a particular drug at an outsized pace that may or may not have a reasonable explanation. The phenomenon is not new, of course, and in fact was the subject of a US Senate Finance Committee probe into prescribing patterns for antipsychotics around the country (back story).
As a result, there is growing interest in prescribing patterns and, for the first time, a link has been established between doctors who write large numbers of prescriptions that are covered by Medicare Part D and the fees these same physicians receive from drugmakers. Not surprisingly, the results are causing concern about undue influence on medical practice and taxpayer budgets.
When there is no evidence that one drug is better than another, "you have to question: Why are doctors prescribing this?" Bernard Lo, president of the Greenwall Foundation, a nonprofit that funds bioethics research, tells ProPublica, which investigated the issue. "What your evidence suggests is that there is a financial incentive for doctors who receive payments from drug companies" for pitching their products.
As an example, ProPublica pointed to Bystolic, a blood pressure pill that was approved in 2008 and is sold by Forest Laboratories (FRX). Last year, the drug notched $348 million in sales, almost double its total from two years earlier. In part, the success is attributed to ties between doctors and the drugmaker - at least 17 of the top 20 Bystolic prescribers in Medicare Part D in 2010 were paid speaking fees by Forest (see this).
In 2012, those doctors received $283,450 for speeches and more than $20,000 in meals, according to data compiled by news site. And nearly all those same doctors were again among the highest prescribers in 2011, the most recent year for which Medicare data are available. Among the 17 top prescribers, speaking fees ranged from $1,250 to $85,750, and seven doctors also received at least $1,000 in meals.
Such relationships can be significant to taxpayers, not just individual patients who may want to know the reasons for receiving a given prescription. Why are there broader implications? As ProPublica notes, Medicare Part D covers about one of every four prescriptions and taxpayers spent $62 billion last year subsidizing the program.
Until now, such connect-the-dot games have been played without far-reaching evidence. The ProPublic analysis marks the first time that payment data made public by various drugmakers have been matched with physician prescribing records from Medicare Part D. Such data will become still more accessible this year when all drugmakers release such data as part of the Sunshine provision of the Affordable Care Act.
Of course, the existence of financial ties between a physician and a drugmaker may not prove conclusively that such incentives can explain all prescribing practices, although as a survey in JAMA Internal Medicine noted in 2010, physicians with industry relationships said they were more likely to prescribe a brand-name drug when a generic was available (more here).
Just the same, as ProPublica also notes, numerous whistleblower lawsuits filed in recent years against many drugmakers have alleged that such payments are, in reality, kickbacks designed to induce prescribing and bolster product revenue. Although the pharmaceutical industry has, collectively, paid billions of dollars to settle these cases, the fines are a smidgen of the total revenue generated.
Rarely, though, do individual physicians get tagged. However, there was one notable instance last year, when a Chicago psychiatrist was charged with receiving illegal kickbacks from drugmakers and for submitting false claims to Medicare and Medicaid for antipsychotics he prescribed for thousands of mentally ill patients in nursing homes. The alleged payments, which were in the form of consulting and speaking deals, and lavish travel reimbursement - came from Novartis NVS) and Teva Pharmaceutical in exchange for prescribing their antipsychotic pills (read more here).
As for Bystolic, the leading prescriber, Gary Reznik, a Los Angeles cardiologist, insists that he does not switch patients to another drug if their blood pressure is under control, but maintains the Forest drug is more effective than rivals meds and has fewer side effects. "I have never felt that there were any expectations or pressure on the part of the company that I would prescribe it more or at all," he tells ProPublica. In 2010, he prescribed the pill more than 2,500 times and more than 2,900 times in 2011.
Yet a few leading cardiologists say there is no evidence that Bystolic is a better choice. “I don't see any purpose for Bystolic whatsoever," Eric Topol, chief academic officer of the Scripps Health system tells the news site, while adding that he doesn't prescribe the drug because it is expensive with no added benefit. "I have no idea how you could come up with a storyline for use of that drug."
STORY ENDS HERE
money pic thx to amagill on flickr