Even small transfers of value from industry may influence prescribing habits
Vision care professionals who receive even small transfers of value from pharmaceutical companies, such as meals, gifts, and travel and speaking fees, are more likely to prescribe branded as opposed to generic drugs, according to a study.
The investigation was carried out specifically on prostaglandin analogues (PGAs) because a generic latanoprost exists as an alternative to the branded drugs and, due to the lower cost, was associated in studies with greater odds of treatment adherence. A retrospective cohort analysis of PGA eye drop prescribers was performed using a nationally representative 20% sample of 2018 Medicare Part D claims and industry transfers of value (TOV) reported to the Open Payments program. A total of 26,038 prescribers, both ophthalmologists and optometrists, were included.
Overall, 16,353 prescribers (63%) were not reported to have received TOV from makers of branded PGAs (Allergan, Merck and Novartis), according to the study. The median total value of reported TOV received amounted to $65, ranging between $24 and $147. However, reported receipt of any non-research TOV was associated with greater likelihood to prescribe the branded drug more than 50% of the time. Food and speaking fees were the TOV more significantly associated with high prescribing.
“The relatively low value of typical reported TOV suggests that monetary gain is not the sole or even primary driver of this association,” the authors wrote.
Psychological drivers, including the exposure effect, the frequency effect and the implicit social pressure toward reciprocity, may better explain why even small TOV exert such an effect.
“These forces work at an unconscious level,” the authors wrote. “[They] cannot be curbed by mere awareness or force of will. So, while ophthalmologists and optometrists may feel that a meal or other small TOV may not influence their behavior, our data suggest that it might.”
The preferential use of branded PGAs imposes on patients a significantly higher cost burden and might result in reduced adherence and worse outcomes. Therefore, “for optometrists and ophthalmologists who care for patients with glaucoma, the results of this study suggest a need to revisit policies and attitudes regarding industry interaction,” the authors wrote.
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