Nearly one-quarter of Medicare's top-prescribing physicians received consulting fees or other financial perks from manufacturers of the drugs they prescribed in 2013, renewing nagging questions about conflicts of interest in medical decisionmaking.
More than 400 physicians prescribed at least $1 million worth of drugs in the Medicare Part D drug benefit program, and 23% of them accepted some form of a non-research payment from the corresponding drugmaker in 2013, according to a Modern Healthcare analysis of the CMS' recent Part D data release and of the Open Payments database.
For instance, Dr. Gavin Awerbuch, a neurologist based in Saginaw, Mich., billed Medicare in 2013 for more than $6.4 million worth of Subsys, a pain reliever for cancer patients. That was the second-highest total for one doctor prescribing a single drug. Insys Therapeutics, the maker of Subsys, paid Awerbuch more than $56,000 that same year for an array of services, including $4,100 for a Subsys-related speaking engagement.
The Justice Department indicted Awerbuch last year, accusing him of fraudulent prescribing of unneeded medication. His case is pending. Calls to Awerbuch, Insys and state prosecutors were not returned.
The Modern Healthcare analysis found that some physicians and provider groups prescribe large volumes of brand-name drugs from pharmaceutical firms and accept money from those same manufacturers. About 17% of the almost 36,000 providers in the Part D database who prescribed $100,000 or more of a single drug received money from the maker of that drug. The same holds true for 20% of the 2,200 physicians who prescribed at least $500,000 of one drug.
In total, the database included more than 800,000 physicians, nurse practitioners and other providers. Actelion Pharmaceuticals, Celgene Corp. and Teva Pharmaceuticals USA were among the drugmakers that appeared often in both databases.
Some experts say these correlations suggest an unholy linkage between prescribing behavior and industry payments to doctors. But others caution that it's hard to draw conclusions without more detailed information about the physicians' practices and the nature of the financial relationships, such as whether the payments are for research or marketing purposes.
“It is frankly magical thinking to believe that those two things are not related,” said Eric Campbell, a Harvard Medical School sociologist who studies conflicts of interest in healthcare. “It's just completely not in the realm of reality to deny—when you see over and over that the highest-paid speakers are among the ranks of the highest prescribers—that there isn't a relationship there.”