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Payments to nonphysicians may increase use of pricier drugs for chronic diseases
Nonphysician health care providers, such as nurses and pharmacists, receive significant payments from the pharmaceutical industry that may result in increased ordering of new, expensive drugs for chronic disease, according to a research letter published in JAMA Internal Medicine.
“Assumptions persist among clinicians and policymakers that marketing to nonphysicians is inconsequential because they do not prescribe; however, emerging evidence suggests that nurses and pharmacists frequently interact with sales representatives,” Emily A. Karanges, PhD, of the Charles Perkins Centre School of Pharmacy at the University of Sydney, New South Wales, Australia, and colleagues wrote.
Beginning in October 2015, pharmaceutical companies have been required to report all payments to health care providers, including nonphysicians, in Australia. Researchers collected data from 168 such reports from Oct. 1, 2015 to April 30, 2018 and matched names of payment recipients to registered health care workers on a national database.
Payments to physicians, nurses, pharmacists, physiotherapists, exercise pathologists, occupational therapists, psychologists, and dietitians were included in the study.
Researchers identified 39,327 industry payments, 16.1% (6,351) of which were made to nonphysicians. A total of 14,018 recipients were identified, of whom 22.1% (3,104) were nonphysicians. Payments to nonphysicians accounted for 10% (AU$6,261,086) of total spending (AU$62,695,095), approximately $4.3 million of $44 million in US dollars.
Nurses and pharmacists were the most common nonphysicians to receive industry payments. Nurses, who received 8.3% (AU$5,185,604) of total spending and pharmacists, who received 1% (AU$654,241) of total spending, were the primary nonphysicians payment recipients. For nurses and pharmacists, 75.9% of payments were attributed to meeting attendance.
Researchers found that Biogen, Gilead, and Shire made the most payments to nonphysicians in Australia during the study period.
After evaluating the five most highly paid individuals in each profession, researchers found that most were involved in chronic disease management, practiced in a hospital, were in positions with clinical seniority, participated in research and had influence in professional organizations.
Karanges and colleagues noted that based on their results, payments made to nonphysicians may be associated with the promotion of expensive, recently subsidized drugs that require high adherence for the treatment of chronic diseases.
In the United States, the Physicians Payments Sunshine Act, which has required public reporting of industry payments to physicians and teaching hospitals since 2010, will begin requiring reporting of payments to prescribing nonphysicians in 2022, according to a letter accompanying the study.
“The Australian experience with broader reporting of industry payments to health care professionals suggests that the forthcoming data should be illuminating,” Colette DeJong, MD, of the department of medicine at the University of California, San Francisco, and Robert Steinbrook, MD, Editor at Large for JAMA Internal Medicine, wrote. “The next steps are to move from greater transparency to reforms that address the high costs of medical care and diminish the incentives for industry payments to health care professionals in the first place.” – by Erin Michael
Disclosures: DeJong, Karanges and Steinbrook report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.