The Continuing Influence of Industry Payments to U.S. Physicians

(A version of this article appeared in the November 2024 issue of Public Citizen’s Health Letter.)

Created in August 2013 as part of the Affordable Care Act, the Open Payments database[1] (https://openpaymentsdata.cms.gov) archives industry payments to U.S. physicians, non-physician practitioners (starting in 2021) and teaching hospitals. Although people can use these data to help decide which clinicians or specialists to see, there is little evidence that they do.[2] Moreover, the public availability of the payment data has not deterred either industry payments or their continuing influence on the medical profession.

Data for 2023, made public in June 2024, cover an astounding 15.64 million records of payments with a total value of $12.75 billion, close to the 2022 total of $12.82 billion.[3] The payments, from 1,776 companies, include general payments totaling $3.29 billion, research payments totaling $8.12 billion and payments totaling $1.34 billion for ownership or investment interests.

Among physicians, 630,384 received payments, including general payments totaling $2.29 billion. The general payments are particularly problematic; the category covers payments not associated with research, such as for consulting services, speaking fees, food and beverages, travel and lodging, entertainment, education, gifts, grants and honoraria.[4] Research studies have consistently found evidence that such payments influence doctors’ prescription decisions and are associated with increased use of a company’s drugs, devices or other medical products.[5]

For August 2013 to December 2022, a study found that the greatest sums of payments were to physicians in the specialties of orthopedics, neurology and psychiatry, cardiology and hematology/oncology.[6] Another recent study, using data from July 2014 to June 2021, found that most cardiology fellows in their final year of training received general payments from pharmaceutical and medical-device manufacturers, with higher rates among those training in subspecialties that frequently perform heart procedures.[7]

For August 2013 to December 2022, the top three drugs related to industry payments were for three widely prescribed brand-name medications: the anticoagulant drugs rivaroxaban (XARELTO) and apixaban (ELIQUIS and generics) and the tumor necrosis factor inhibitor adalimumab (HUMIRA and biosimilars), a treatment for rheumatoid arthritis and various autoimmune diseases. Over the nearly 10-year period, industry payments for each of these drugs totaled $100 million or more. In 2022, Medicare spent $5.77 billion on rivaroxaban for 1.3 million beneficiaries.[8]

Other than support for legitimate research, with payments made to the researchers’ institution and governed by the institution’s policies and procedures or bona fide consulting related to product development or specific research programs and projects, there are usually no reasons for physicians to have financial associations with industry. Some of the payments may conflict with the federal Anti-Kickback Statute,[9] a criminal law that “prohibits the knowing and willful payment of ‘remuneration’ to induce or reward patient referrals or the generation of business involving any item or service payable by federal health care programs,” such as for drugs, supplies or health care services. Other payments — such as for promotional speaking, meals or entertainment — may be legal, but that doesn’t mean that clinicians should expect or accept them.

The public availability of payment data has done little to curb industry influence over physicians. If individuals, professional societies and health care organizations are unable or unwilling to achieve a higher professional standard, further legal restrictions may be needed.
 

References

[1] Centers for Medicare & Medicaid Services. Open Payments. https://openpaymentsdata.cms.gov. Accessed September 11, 2024.

[2] Tokar D. Ten years of payment disclosure does little to curtail corporate influence over doctors. Wall Street Journal. July 23, 2024. https://www.wsj.com/articles/ten-years-of-payment-disclosure-does-little-to-curtail-corporate-influence-over-doctors-89a6e226. Accessed September 11, 2024.

[3] Centers for Medicare & Medicaid Services. Open Payments. Facts about Open Payments data. https://openpaymentsdata.cms.gov/summary. Accessed September 11, 2024.

[4] Sayed A, Ross JS, Mandrola J, et al. Industry payments to US physicians by specialty and product type. JAMA. 2024;331(15):1325-1327. doi:10.1001/jama.2024.1989. https://jamanetwork.com/journals/jama/fullarticle/2816900. Accessed September 11, 2024.

[5] Steinbrook R. Industry payments to physicians and prescribing of brand-name drugs. JAMA Intern Med. 2016;176(8):1123. doi:10.1001/jamainternmed.2016.2959. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2528285. Accessed September 11, 2024.

[6] Sayed A, Ross JS, Mandrola J, et al. Industry payments to US physicians by specialty and product type. JAMA. 2024;331(15):1325-1327. doi:10.1001/jama.2024.1989. https://jamanetwork.com/journals/jama/fullarticle/2816900. Accessed September 11, 2024.

[7] Dhruva SS, Han M, Jing Y, et al. Industry payments to cardiology fellows and early-career cardiologists. JAMA Intern Med. 2024;184(9):1123-1125. doi:10.1001/jamainternmed.2024.3130. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2821267. Accessed September 11, 2024.

[8] Medicare Part D drug spending dashboard. https://data.cms.gov/tools/medicare-part-d-drug-spending-dashboard. Accessed September 11, 2024.

[9] Tokar D. Ten years of payment disclosure does little to curtail corporate influence over doctors. Wall Street Journal. July 23, 2024. https://www.wsj.com/articles/ten-years-of-payment-disclosure-does-little-to-curtail-corporate-influence-over-doctors-89a6e226. Accessed September 11, 2024.

[10] Anti-Kickback Statute [42 U.S.C. § 1320a-7b(b)]. https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/#:~:text=The%20AKS%20is%20a%20criminal,for%20Medicare%20or%20Medicaid%20patients. Accessed September 11, 2024.