This week, a research letter appearing JAMA Internal Medicine reported on efforts to understand whether there exists an association between payments from drug makers and Medicare spending on adalimumab and certolizumab.
Biologic therapies have revolutionized the treatment of a number of inflammatory diseases, including inflammatory bowel disease (IBD), but the cost burden of these products has strained the US healthcare system. Among Medicare beneficiaries, adalimumab (Humira) and certolizumab (Cimzia), 2 particularly high-cost therapies, are the most frequently prescribed biologics for IBD. This week, a research letter appearing JAMA Internal Medicine reported on efforts to understand whether there exists an association between payments from the drug’s makers and Medicare spending on these products.
The investigators, led by Rishad Khan, MD, of the University of Toronto, used data from 2014 to 2016 from the CMS Open Payments database for biologics that treat ulcerative colitis and Crohn disease and that were prescribed by more than 100 gastroenterologists to Medicare beneficiaries.1 Payments included in the analysis were made for education; food, travel, and lodging expenses; and speaking and consulting (research payments were not included in the analysis).
Khan and colleagues found that, for adalimumab, payments made to physicians were $13,034 for education; $4,953,998 for food, travel, and lodging expenses; and $5,580,947 for speaking and consulting. For certolizumab, payments made for the same 3 categories were $60,369, $117,554, and $180,285, respectively.
They also found that there was a significant association between industry payments and Medicare spending; for every dollar of payment, there was a $3.16 increase in spending on adalimumab and a $4.72 increase on spending for certolizumab.
These findings persisted even when considering smaller payments, higher-volume prescribers, and different types of payment, say the authors.
In a linked commentary, JAMA’s editor at large, Robert Steinbrook, MD, adds that “Association studies do not establish cause and effect, they do not account for other influences on prescribing, such as direct-to-consumer advertising, and they do not assess the appropriateness of prescriptions for individual patients. Nonetheless, the pattern is indisputable. Companies can use the same federal databases that researchers use to calculate the return on investment for marketing expenditures.”2
Steinbrook writes that the observed link between industry payments and prescribing raises “troubling questions” about whether physicians should accept such payments at all, and calls on his peers to prescribe generic alternatives when choices are available.
1. Khan R, Nugent CM, Scaffidi MA, Grover SC. Association of biologic prescribing for inflammatory bowel disease with industry payments to physicians [published online July 8, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.0999.
2. Steinbrook R. Industry payments and physician prescribing [published online July 8, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.1081.