Report: Pharma Gifts May Double Use of Branded Prostaglandins

A majority of physicians believe small gifts, such as meals or travel events provided by pharmaceutical companies while educating providers about a product, will not influence whether they prescribe the medicine, according to prior studies. In contrast, an investigation published in JAMA Ophthalmology presents data suggesting the acceptance of fairly small transfers of value (TOV) will nearly double most clinicians’ preference of branded prostaglandin (PG) analog eye drops, with some prescribing patterns independent of specialty or subspecialty.

Researchers relied on a 20% sample characteristic of the 2018 Centers for Medicare & Medicaid Services (CMS) Part D Event dataset, and includes 26,038 providers with more than 10 claims (5426 optometrists; and 20,612 ophthalmologists, of which 1103 are glaucoma specialists). For these, 16,353 (63%) providers did not report any PG analog-related gifts, prescribing branded drops at a rate of approximately 12.9%. This percentage reached 19.6% for those offered food/drink, travel, or speaking or consulting fees.

Urban clinicians received — in median (interquartile range) — TOVs of $68 ($25 to $151), compared with rural colleagues at $43 ($17 to $102); and ophthalmologists obtained gifts of $68 ($25 to $150), compared with optometrists at $54 ($23 to $131). Glaucoma specialists received gifts of $140 ($54 to $352).

“The distribution of reported TOV was skewed, with the top 25% of recipients receiving 92% of the total value of reported TOV from PGA makers ($4,661,511 of $5,060,346) and the top 10% receiving 86%($4,363,829 of $5,060,346),” according to the study. 

Clinicians who accepted the most TOVs — in the top half of recipients, were 1.8 times more likely to prescribe branded eye drops more than 50% of the time by days supplied (P <.001), and those in the top 10% had a 2.3 times greater chance for high prescribing (P <.001).

Clinicians in the same 3-digit zip codes adapted similar patterns of nearby colleagues. In regions with branded prostaglandin use at 20%, there was an 8.8% estimated marginal probability of high prescribing, but this likelihood rose to 18.7% in areas with 31% branded drop preference (both 95% CI, P <.001). Overall data showed similar results for optometrists and ophthalmologists.

The investigators speculate that the somewhat low dollar value of TOVs reveal financial reasons are secondary to psychological tendencies for reciprocity, collegiality, or the frequent exposure to positive information about a branded medication. Researchers conclude that since official conflicts of interest typically involve financial gain, but pressure toward reciprocal social action is largely unconscious, “the results of this study suggest a need to revisit policies and attitudes regarding industry interaction.” High patient cost may affect eye drop compliance, they added.

Drug and medical supply manufacturers are required to report nonresearch TOVs to the CMS since 2010, with the Physician Payments Sunshine Act, part of the Affordable Care Act. The database became public in 2014, and research so far has explored prescription patterns for anti-vascular endothelial growth factor (anti-VEGF), but for these agents Medicare Part B buy and bill pays typical cost plus an added percentage. Thus, the current analysis examines PG analog drops covered by Medicare Part D.

A limitation of this analysis is use of retrospective, cross-sectional data which does not demonstrate causality — clinicians who favor branded medicines may be more frequently approached by drug marketers. 

Disclosures: Some study authors have disclosed affiliations with biotechnology and medical device companies and/or charitable foundations. Please see the original reference for a full list of disclosures.