Friday, August 28, 2020

Drug Company Payments to Doctors Linked to Higher Pimavanserin Prescribing, Medicare Costs

Higher physician payments from drug manufacturer Acadia for Nuplazid (pimavanserin) are associated with increased pimavanserin prescription volume and Medicare costs, a study in Psychiatric Services in Advance has found. Pimavanserin is approved by the U.S. Food and Drug Administration for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis. Physician payments include payments for speaking, consulting, education, food, travel, and lodging.

“Our study adds to the growing evidence of the association between pharmaceutical industry payments to physicians and physician prescribing,” wrote Hemalkumar B. Mehta, M.S., Ph.D., of the Johns Hopkins Bloomberg School of Public Health and colleagues.

The researchers analyzed 2016 and 2017 data from the Centers for Medicare and Medicaid Services (CMS) Open Payments database and the CMS Part D Prescriber Public Use Files. The Open Payments database contains information on financial payments made by drug and medical device companies to physicians and teaching hospitals. The Part D prescriber data provide information on physician specialties and which drugs they prescribe to Medicare Part D beneficiaries.

The researchers found that physicians receiving payments wrote 46% more prescriptions for pimavanserin than those who did not receive payments, and their total prescriptions were 71% more costly to Medicare, totaling a median of $66,311 compared with a median of $38,716 for those who did not receive payments. Of 1,609 physicians who prescribed pimavanserin, 45% had received payments totaling $6,369,922. Each $10,000 in physician payments was associated with a 14% increase in pimavanserin prescription volume. Every $100 in physician payments was associated with a $175.84 increase in Medicare pimavanserin expenditures.

Half of the physicians who prescribed pimavanserin were neurologists, who received a combined $4,764,689. Seven percent of the physicians who prescribed pimavanserin were psychiatrists, who received a combined $1,462,615. Overall, psychiatrists received higher payments than neurologists, with a median of $13,543 compared with $5,890. However, Medicare expenditures associated with pimavanserin prescribing were lower for psychiatrists than for neurologists. Other medical specialists received a combined total of $142,618. The bulk of the payments, more than $5.6 million, were for speaking, consulting, and education, with the rest for food, travel, and lodging.

The researchers noted several possible reasons for the association between consulting and speaking fees paid to physicians and higher pimavanserin prescription volume.

“Physicians receiving industry payments are often content experts or key opinion leaders; in this study, physicians may have been selected on the basis of their experience treating Parkinson’s disease,” they wrote. “These prescribers also may have participated in clinical trials of the product or have otherwise interacted with pharmaceutical company representatives.”

For more information, see the Psychiatric News article, “Experts Discuss Challenges of Treating Neuropsychiatric Symptoms of Dementia.”


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