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Report: Top-Prescribing Medicare Doctors Receive Payments From Drug-Makers

Some experts see link between prescribing behaviors and industry dollars

An analysis posted on the Modern Healthcare website finds that about 23% of the more than 400 Medicare providers who prescribed $1 million or more of a drug received some form of non-research payment from the corresponding drug-maker in 2013.

For example, a neurologist in Saginaw, Michigan, billed Medicare for more than $6.4 million worth of Subsys (fentanyl sublingual spray), a pain reliever for cancer patients. That was the second-highest total for one doctor prescribing a single drug. Insys Therapeutics, the maker of Subsys, paid the clinician more than $56,000 that same year for an array of services, including $4,100 for a Subsys-related speaking engagement, according to the report.

The Justice Department indicted the neurologist last year, accusing him of fraudulent prescribing of unneeded medication, and his case is pending.

Modern Healthcare analyzed the Centers for Medicare & Medicaid Services’ (CMS) recent Part D data release and the Open Payments database. They found that some physicians and provider groups prescribe large volumes of brand-name drugs from pharmaceutical firms and accept money from those same manufacturers. About 17% of the almost 36,000 providers in the Part D database who prescribed $100,000 or more of a single drug received money from the maker of that drug. The same was true for 20% of the 2,200 physicians who prescribed at least $500,000 of one drug.

In total, the database included more than 800,000 physicians, nurse practitioners, and other providers.

Some experts say these correlations suggest a link between prescribing behaviors and industry payments to doctors, the report says. But others caution that it’s difficult to draw conclusions without more detailed information about the physicians’ practices and the nature of the financial relationships, such as whether the payments were for research or marketing purposes.

The CMS cautioned that payments to providers from drug-makers and biotechnology companies don’t necessarily mean there is a conflict of interest. The agency said in a written statement that it has “a range of tools” in place to track fraudulent behavior and odd prescribing patterns. “Information about financial relationships alone is not enough to decide whether they’re beneficial or improper,” according to the CMS. “Just because there are financial ties doesn’t mean that anyone is doing anything wrong. Transparency will shed light on the nature and extent of these financial relationships and will hopefully discourage the development of inappropriate relationships.”

Modern Healthcare acknowledges that there are some caveats in analyzing the Part D and Open Payments data. Not all the physicians listed equate to one individual physician. In some instances, all of the providers in one medical group bill Medicare under one doctor’s name. Some physicians may then appear to be prescribing higher amounts of certain drugs than is actually the case.

In addition, the data are somewhat incomplete, and there are inconsistencies in provider information between the two databases, the report says. The Open Payments database, created by the Physician Payments Sunshine Act provision of the Patient Protection and Affordable Care Act, does not give specific provider identities for 60% of reported payments. Consequently, Modern Healthcare’s analysis covers only the $1.4 billion of identified payments. In addition, the Open Payments database accounts only for the last 5 months of 2013, meaning that payments from drug companies to providers are potentially even higher. The next round of Open Payments data will go “live” on June 30.

Source: Modern Healthcare; May 23, 2015.


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