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Association Between Payments by Pharmaceutical Manufacturers and Prescribing Behavior in Rheumatology



      To evaluate the association between pharmaceutical industry payments to rheumatologists and their prescribing behaviors.


      A cross-sectional analysis was conducted of Medicare Part B Public Use File, Medicare Part D Public Use File, and Open Payments data for 2013 to 2015. Prescription drugs responsible for 80% of the total Medicare pharmaceutical expenditures in rheumatology were analyzed. We calculated the mean annual drug cost per beneficiary per year, the percentage of rheumatologists who received payments, and the median annual payment per physician per drug per year. Industry payments were categorized as food/beverage and consulting/compensation. Multivariable regression models were used to assess associations between industry payments and both prescribing patterns and prescription drug expenditures.


      Of 4822 rheumatologists in the Medicare prescribing databases, 3729 received any payment from a pharmaceutical company during this time frame. Food/beverage payments were associated with an increased proportion of prescriptions for the related drugs (range, 1.5% to 4.5%) and an increased proportion of annual Medicare spending for the related drugs (range, 3% to 23%). For every $100 in food/beverage payments, the probability of prescribing increased (range, 1.5% to 14% for most drugs) and Medicare reimbursements increased (range, 6% to 44% for most drugs). Consulting/compensation payments were associated with an increased proportion of prescriptions (range, 1.2% to 1.6%) and an increased proportion of annual Medicare spending (range, 1% to 2%). For every $1000 in consulting/compensation payments, both the probability of prescribing increased (5% or less for most drugs) and Medicare reimbursements increased (less than 10% for most drugs).


      Payments to rheumatologists by pharmaceutical companies are associated with increased probability of prescribing and Medicare spending.

      Abbreviations and Acronyms:

      CMS (Centers for Medicare and Medicaid Services), NPI (National Provider Identifier), PUF (Public Use File), rACTH (repository corticotropin)
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        • Hartman M.
        • Martin A.B.
        • Espinosa N.
        • Catlin A.
        The National Health Expenditure Accounts Team. National health care spending in 2016: spending and enrollment growth slow after initial coverage expansions.
        Health Aff (Millwood). 2018; 37: 150-160
        • Grabowski H.G.
        • Guha R.
        • Salgado M.
        Regulatory and cost barriers are likely to limit biosimilar development and expected savings in the near future.
        Health Aff (Millwood). 2014; 33: 1048-1057
        • Genetic Engineering and Biotechnology News
        • The top 15 best-selling drugs of 2016
        (Accessed March 5, 2021)
        • Spatz I.
        • McGee N.
        • Brennan T.A.
        • Berndt E.
        • Lott R.
        Health policy brief: specialty pharmaceuticals.
        Health Affairs. November 25, 2013;
      1. Trends in FDA approval of specialty drugs 1990 through 2017.
        (Accessed September 22, 2021)
        • Erath A.
        • Dusetzina S.B.
        Assessment of expected out-of-pocket spending for rheumatoid arthritis biologics among patients enrolled in Medicare Part D, 2010-2019.
        JAMA Netw Open. 2020; 3: e203969
        • Wazana A.
        Physicians and the pharmaceutical industry: is a gift ever just a gift?.
        JAMA. 2000; 283: 373-380
        • Estellat C.
        • Ravaud P.
        Lack of head-to-head trials and fair control arms: randomized controlled trials of biologic treatment for rheumatoid arthritis.
        Arch Intern Med. 2012; 172: 237-244
        • Ioannidis J.P.
        • Karassa F.B.
        • Druyts E.
        • Thorlund K.
        • Mills E.J.
        Biologic agents in rheumatology: unmet issues after 200 trials and $200 billion sales.
        Nat Rev Rheumatol. 2013; 9: 665-673
        • MacKenzie C.R.
        • Meltzer M.
        • Kitsis E.A.
        • Mancuso C.A.
        Ethical challenges in rheumatology: a survey of the American College of Rheumatology membership.
        Arthritis Rheum. 2013; 65: 2524-2532
        • DeJong C.
        • Aguilar T.
        • Tseng C.
        • Lin G.A.
        • Boscardin W.
        • Dudley R.
        Pharmaceutical industry–sponsored meals and physician prescribing patterns for Medicare beneficiaries [erratum appears in JAMA Intern Med. 2016;176(9):1411-1412].
        JAMA Intern Med. 2016; 176: 1114-1122
        • Fleischman W.
        • Agrawal S.
        • King M.
        • et al.
        Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study.
        BMJ. 2016; 354: i4189
        • Yeh J.S.
        • Franklin J.M.
        • Avorn J.
        • Landon J.
        • Kesselheim A.S.
        Association of industry payments to physicians with the prescribing of brand-name statins in Massachusetts.
        JAMA Intern Med. 2016; 176: 763-768
        • Association of American Medical Colleges
        2016 Physician specialty data report.
        (Accessed September 22, 2021)
        • Centers for Medicare & Medicaid Services
        CMS releases prescriber-level Medicare data for first time.
        (Accessed September 22, 2021)
        • Centers for Medicare & Medicaid Services
        Open Payments data summary.
        (Accessed September 22, 2021)
        • Centers for Medicare & Medicaid Services
        Physician compare.
        (Accessed March 5, 2021)
        • Centers for Medicare & Medicaid Services
        Medicare fee-for-service provider utilization & payment data physician and other supplier public use file: a methodological overview.
        (Accessed September 22, 2021)
        • Centers for Medicare & Medicaid Services
        Prescription drugs (outpatient).
        (Accessed September 22, 2021)
        • Centers for Medicare & Medicaid Services
        Medicare fee-for service provider utilization & payment data Part D prescriber public use file: a methodological overview.
        (Accessed September 22, 2021)
        • Battafarano D.F.
        • Ditmyer M.
        • Bolster M.B.
        • et al.
        2015 American College of Rheumatology workforce study: supply and demand projections of adult rheumatology workforce, 2015-2030.
        Arthritis Care Res (Hoboken). 2018; 70: 617-626
        • Taylor S.C.
        • Huecker J.B.
        • Gordon M.O.
        • Vollman D.E.
        • Apte R.S.
        Physician-industry interactions and anti–vascular endothelial growth factor use among US ophthalmologists.
        JAMA Ophthalmol. 2016; 134: 897-903
        • Zhang J.
        • Xie F.
        • Delzell E.
        • et al.
        Trends in the use of biologic agents among rheumatoid arthritis patients enrolled in the US Medicare program.
        Arthritis Care Res (Hoboken). 2013; 65: 1743-1751
        • Mitchell A.P.
        • Trivedi N.U.
        • Gennarelli R.L.
        • et al.
        Are financial payments from the pharmaceutical industry associated with physician prescribing? A systematic review.
        Ann Intern Med. 2021; 174: 353-361
        • Duarte-Garcia A.
        • Matteson E.L.
        • Shah N.D.
        Older drugs with limited trial evidence: are they worth the expense?.
        Ann Intern Med. 2019; 171: 602
      2. Veterans Affairs pharmacy formulary.
        (Accessed September 22, 2021)
        • Huskamp H.A.
        • Deverka P.A.
        • Epstein A.M.
        • Epstein R.S.
        • McGuigan K.A.
        • Frank R.G.
        The effect of incentive-based formularies on prescription-drug utilization and spending.
        N Engl J Med. 2003; 349: 2224-2232
        • Inoue K.
        • Figueroa J.F.
        • Orav E.J.
        • Tsugawa Y.
        Association between industry payments for opioid products and physicians' prescription of opioids: observational study with propensity-score matching.
        J Epidemiol Community Health. 2020; 74: 647-654
        • Hadland S.E.
        • Cerda M.
        • Li Y.
        • Krieger M.S.
        • Marshall B.D.L.
        Association of pharmaceutical industry marketing of opioid products to physicians with subsequent opioid prescribing.
        JAMA Intern Med. 2018; 178: 861-863