The healthcare reform law may not do enough to deter doctors who prescribe costly medications, a new study reveals. See why legislators may be disappointed.
Drug company disclosures of the consulting assignments, honoraria, gifts, and travel perks they give to physicians are having little to no effect on what medications you and your colleagues prescribe, according to a recent study.
Genevieve Pham-Kanter, PhD, and colleagues examined the impact of the Physician Payments Sunshine Provision of the Affordable Care Act and published their findings in the Archives of Internal Medicine. The idea behind the provision was that doctors would hesitate to take large payments from drug companies if the public was aware of the payments and perceived them to be compensation for prescribing certain medications. She added, however: “If the policymakers who passed these measures were hoping for a deterrent effect, they may be disappointed.”
Pham-Kanter is an assistant professor in the Department of Health Systems, Management, and Policy at the Colorado School of Public Health; an assistant professor of economics at the University of Colorado; and a research fellow at Harvard University and Massachusetts General Hospital.
She and her fellow investigators researched the effect of the laws on the prescribing of HMG-CoA reductase inhibitors (statins) and selective serotonin reuptake inhibitors (SSRIs). Members of each class of drug are similar and highly substitutable, Pham-Kanter says, so marketing plays a heavy role in a physician’s choice of therapy. The researchers theorized that if disclosure laws were effective and doctors were deterred from accepting payments from pharmaceutical companies, they would, in turn, be less likely to prescribe branded statins and SSRIs instead of similar generic drugs.
Using a wide variety of public data, they compared prescribing habits in Maine, which enacted a disclosure law in 2004, with those in New Hampshire and Rhode Island, two demographically similar states without such laws. Then they compared prescribing habits in West Virginia, which also passed a disclosure law in 2004, with those of Kentucky and Delaware, which had none.
In Maine, the law was associated with a 0.8 percentage point reduction in the prescribing of branded statins compared with New Hampshire and a 5.3 percentage point reduction compared with Rhode Island. The researchers found little to no effect in West Virginia.
“Our results show that the disclosure laws in the two states we examined had a negligible to small effect on physicians switching from branded therapies to generics and no effect on reducing prescription costs,” Pham-Kanter says.
Despite the laws, she adds, accessing information about how much money a doctor received from a pharmaceutical company is still difficult. Much of the information is not online yet.
“Transparency is important in its own right, but if deterring unnecessary, costly prescribing is a concern for policymakers, more direct action may be required,” Pham-Kanter concludes.
Go back to current issue of eConsult