Drugmakers and medical device makers paid more than 700 physicians at least $1 million each in the past four years, according to an analysis of CMS' Open Payments database released by ProPublica on Thursday. 

Background

A number of studies have found a link between the drugs and devices doctors choose to use with their patients and payments they receive from drugmakers and device makers, ProPublica reports.

For instance, Aaron Mitchell, a medical oncologist and health services researcher at Memorial Sloan Kettering Cancer Center, said his research found doctors who consistently interact with a drugmaker are more likely to prescribe that drugmaker's cancer drug. Mitchell said the pharmaceutical industry "knows that they need to cultivate relationships over more time, so that's what they're really trying to do. It's not just one drug meal. It's consistency."

CMS in 2014 launched its Open Payments database under the Affordable Care Act (ACA) to publicly disclose industry payments made to doctors. The database includes payments drugmakers and device makers made to doctors for consulting, promotional engagements, meals, and other expenses.

Experts and physicians had predicted that the public disclosures under the ACA would cause drugmakers, device makers, and doctors to reconsider whether to make or accept payments.

ProPublica examined the data to see how the public disclosures affected the payments drugmakers and device makers made to doctors. ProPublica in total analyzed more than $56 million in payments companies made to doctors from 2014 to 2018.

Analysis findings

Overall, ProPublica found 1 million chiropractors, doctors, dentists, optometrists, and podiatrists received at least one payment—typically a meal—from drugmakers or device makers from 2014 to 2018.

Among the practitioners, ProPublica found:

• About 240,000 had received just one payment;
• More than 323,000 had received at least one payment annually; and
• The remainder had received payments for more than one year, but for less than all five years.

According ProPublica's analysis, drugmakers and device makers paid more than 600,000 doctors between $2.1 billion and $2.2 billion for consulting, gifts, travel, speaking engagements, and royalties each year from 2014 to 2018. Specifically, ProPublica found the companies paid more than 2,500 doctors at least half a million dollars apiece. Among those doctors, ProPublica found more than 700 received payments of at least $1 million.

In addition, ProPublica found the number of doctors who received payments of $100,000 or more for services other than consulting increased from 816 in 2014 to 1,084 in 2018.

ProPublica also found that drugmakers spent more on provider payments related to certain prescription drugs between 2014 and 2018. For example, ProPublica found drugmakers during the four years had spent more than $123 million in payments related to Xarelto, a blood thinner. According to ProPublica, the highest payments over the four years were tied to six prescriptions drugs:

• Aubagio, multiple sclerosis drug;
• Invokana, a type 2 diabetes treatment;
• Humira, an immunosuppressive drug;
• Latuda, an antipsychotic; and
• Xarelto and Eliquis, two blood thinner drugs.

According to ProPublica, the analysis suggested there has been virtually no change in how much drugmakers and device makers pay doctors since CMS launched its Open Payments database.

Comments

Joseph Ross—a professor of medicine and public health at Yale University, who has examined pharmaceutical marketing—said the analysis "makes [him] wonder whether patients are using this information or whether physicians are even aware this information is out there." He added, "It's almost like it's not happening."

Walid Gellad, an associate professor of medicine and health policy at the University of Pittsburgh, said it is "quite striking" how much doctors received in payments from "activities aside from patient care."

However, Holly Campbell, a spokesperson for the Pharmaceutical Research and Manufacturers of America, said, "It is not necessarily a negative that the numbers have remained generally flat over the past five years. That statistic appears to be consistent with companies' belief that their interactions with physicians have been and remain legitimate, even when subjected to sunshine" (Ornstein, ProPublica, 10/17).