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Original Investigation |

Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries

Colette DeJong, BA1; Thomas Aguilar, MS1; Chien-Wen Tseng, MD, MPH2,3; Grace A. Lin, MD, MAS1,4; W. John Boscardin, PhD5; R. Adams Dudley, MD, MBA1,4
[+] Author Affiliations
1Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco School of Medicine
2Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Honolulu
3Pacific Health Research and Education Institute, Honolulu, Hawaii
4Department of Medicine, University of California, San Francisco School of Medicine
5Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine
JAMA Intern Med. 2016;176(8):1114. doi:10.1001/jamainternmed.2016.2765.
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Importance  The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available.

Objective  To study the association between physicians’ receipt of industry-sponsored meals, which account for roughly 80% of the total number of industry payments, and rates of prescribing the promoted drug to Medicare beneficiaries.

Design, Setting, and Participants  Cross-sectional analysis of industry payment data from the federal Open Payments Program for August 1 through December 31, 2013, and prescribing data for individual physicians from Medicare Part D, for all of 2013. Participants were physicians who wrote Medicare prescriptions in any of 4 drug classes: statins, cardioselective β-blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs), and selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). We identified physicians who received industry-sponsored meals promoting the most-prescribed brand-name drug in each class (rosuvastatin, nebivolol, olmesartan, and desvenlafaxine, respectively). Data analysis was performed from August 20, 2015, to December 15, 2015.

Exposures  Receipt of an industry-sponsored meal promoting the drug of interest.

Main Outcomes and Measures  Prescribing rates of promoted drugs compared with alternatives in the same class, after adjustment for physician prescribing volume, demographic characteristics, specialty, and practice setting.

Results  A total of 279 669 physicians received 63 524 payments associated with the 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20. Rosuvastatin represented 8.8% (SD, 9.9%) of statin prescriptions; nebivolol represented 3.3% (7.4%) of cardioselective β-blocker prescriptions; olmesartan represented 1.6% (3.9%) of ACE inhibitor and ARB prescriptions; and desvenlafaxine represented 0.6% (2.6%) of SSRI and SNRI prescriptions. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins (odds ratio [OR], 1.18; 95% CI, 1.17-1.18), nebivolol over other β-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates.

Conclusions and Relevance  Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.

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Figure 1.
Target Branded Drugs as a Percentage of All Filled Prescriptions in the Class in 2013, Across Days Receiving Target Drug–Sponsored Meals

Filled prescriptions for each target branded drug are shown as a percentage of all prescriptions within the class, according to number of days receiving target drug-sponsored meals. A, Statins. B, Cardioselective β-blockers. C, Angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs). D, Selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). Sample sizes for Figure 1 are shown in the last 5 rows of Table 2. Error bars indicate 95% confidence intervals.

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Figure 2.
Predicted Probabilities for Prescribing the Target Drug as a Percentage of All Prescriptions in the Class, According to the Number and Cost of Sponsored Meals Received by Each Physician

The figure shows predicted probabilities for prescribing the target drug over alternatives within the treatment class, based on the cost and number of meals received promoting the target drug. Predicted probabilities are calculated for physicians with the highest-frequency values of all characteristics in Table 1 (male sex, internal medicine specialty, Southern region, urban location, group size ≥51, ≥20 years since medical school graduation, and mean values for prescribing volume, income in zip code, and percentage of low-income subsidy and Medicare Advantage Part D patients). A, Statins. B, Cardioselective β-blockers. C, Angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs). D, Selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). Error bars indicate 95% confidence intervals.

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free lunch
Posted on June 22, 2016
grumpy
private practice
Conflict of Interest: None Declared
i don't take time for reps lunches
however i \"use\" them to educate me
What do you have? What is it for? what are advantages? Cost? Ins coverage?
Leave samples and i may try it
Truly not an abuse as other industries have.
Why pick on doctors?
Perhaps Higher Prescribing Rates Produce Free Cheap Lunches
Posted on June 24, 2016
Stanley Hoffman, M.D.
Private Practice
Conflict of Interest: None Declared
Pharmaceutical Reps don't have an unlimited budget for lunches. Perhaps the causality runs the other way. I get very few lunches but they are from reps who promote drugs that I am already prescribing. Expensive drugs like Jublia that I absolutely refuse to prescribe result in being dropped from the reps route, not only don't they not bring lunches, they just avoid my office.

It's not physicians being bribed, it's reps offering a little something to their best prescribers. Occasionally, they bring by copies of the latest studies or new indications.
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