Analysis Reveals High Percentage of Neurologists Receive Pharma Payments for MS Drugs

A recent analysis has uncovered that nearly 80% of neurologists in the United States who prescribe medications for multiple sclerosis (MS) have accepted payments from pharmaceutical companies. This study, published in the journal BMJ Open, highlights a potential link between financial incentives and prescribing patterns.

The researchers conducted a five-year examination of the Medicare database, focusing on payments made to neurologists for prescribing disease-modifying therapies (DMTs). The findings indicate that those neurologists who received payments were significantly more likely to prescribe the medications produced by the companies that compensated them. Notably, the likelihood of preferential prescribing increased with the amount of payment received, particularly for higher-volume prescribers.

Due to the chronic nature of multiple sclerosis, effective therapies typically require long-term use unless a patient's response necessitates a change. MS drugs represent the largest expenditure for neurological medications under Medicare, despite accounting for a relatively small fraction of total claims.

While previous studies have suggested a correlation between industry payments and increased prescribing of branded products, this research is unique in its focus on the competitive MS drug market. The study aimed to understand the extent and nature of payments made to neurologists and their potential influence on prescribing behaviors.

Utilizing publicly available data from the Centers for Medicare & Medicaid Services' Open Payments platform, researchers analyzed general payments made to neurologists from 2015 to 2019. They categorized payments into research, ownership and investment interests, and general payments, with a primary focus on general payments linked to Medicare Part D prescription data.

The analysis encompassed 7,401 neurologists who had prescribed DMTs for a minimum of one year and issued at least 11 prescriptions, covering 20 different DMTs manufactured by 10 pharmaceutical companies. A total of 5,809 neurologists, representing 78.5% of the group, received a total of 626,290 payments from pharmaceutical companies, amounting to $163.6 million during the study period. Additionally, 67.5% of neurologists received payments from multiple companies.

On average, each neurologist received around $779; however, a small percentage of recipients garnered the vast majority of the funds, with 10% receiving $155.7 million collectively, indicating that pharmaceutical companies may strategically target high-volume prescribers.

Higher prescription volumes correlated with an increased likelihood of receiving payments, particularly for consulting services, speaking engagements, and travel or accommodation expenses, with food and drink accounting for the highest number of discrete payments.

The analysis revealed that neurologists who received payments were 13% more likely to prescribe drugs from the payer company compared to those who received no payments. The strongest correlations were found for non-consulting services, where neurologists were 53% more likely to prescribe related medications.

Moreover, the magnitude of payments was directly associated with prescribing behavior; for instance, a payment of $500 was linked to a 26% higher chance of prescribing that company's drugs, while a $5,000 payment increased the likelihood by 50%. Additionally, the duration and recency of payments played a significant role, with longer payment histories correlating with higher prescribing rates.

This observational study does not establish causation and is limited to the analysis of Part D drugs, making it impossible to determine the appropriateness of prescriptions or identify which patients might benefit most from higher-priced brand-name medications.

Numerous factors influence a physician's prescribing decisions, including clinical guidelines, insurance coverage, and patient preferences. The researchers stress that these factors should be taken into account when interpreting their findings. They express concern over the implications of pharmaceutical promotion on physician prescribing patterns, particularly regarding the high costs associated with some MS therapies.

The Physician Payments Sunshine Act, which established the Open Payments Database, marked a significant advancement in transparency regarding financial conflicts of interest among physicians. However, it remains uncertain whether this transparency has effectively reduced conflicts of interest or merely illuminated the extensive nature of industry payments to prescribers.