Implementation of policies at academic medical centers that restricted pharmaceutical detailing (pharmaceutical representative sales visits to physicians) was associated with modest but significant reductions in prescribing of detailed drugs across six of eight major drug classes; however, changes were not seen in all of the academic medical centers that enacted policies, according to a study published by JAMA in a theme issue on conflict of interest.
In an effort to regulate physician conflicts of interest, a number of academic medical centers (AMCs) enacted policies between 2006 and 2012 restricting sales visits from pharmaceutical representatives to their practicing physicians, by far the most common form of interaction between physicians and the pharmaceutical industry. Little is known about the effect of these policies on physician prescribing. Ian Larkin, Ph.D., of the University of California, Los Angeles, and colleagues compared changes in prescribing by physicians 10 to 36 months before and 12 to 36 months after implementation of detailing policies at AMCs in five states (California, Illinois, Massachusetts, Pennsylvania and New York; intervention group) with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy.
The analysis included 16,121,483 prescriptions written between January 2006 and June 2012 by 2,126 attending physicians at 19 intervention group AMCs and by 24,593 matched control group physicians. The researchers found that enactment of detailing restrictions at AMCs was associated with a decrease in the prescribing of detailed drugs of 1.67 percentage points of market share, and an increase in prescribing of nondetailed drugs of 0.84 percentage points. The average detailed drug had a market share of 19.3 percent and the average nondetailed drug had a market share of 14.2 percent. Associations were statistically significant for six of eight study drug classes for detailed drugs (lipid-lowering drugs, gastroesophageal reflux disease drugs, antihypertensive drugs, sleep aids, attention-deficit/hyperactivity disorder drugs, and antidepressant drugs) and for nine of the 19 AMCs that implemented policies. Across AMCs and drug classes, prescriptions shifted away from detailed drugs and toward generic drugs following the introduction of policies restricting pharmaceutical detailing.
Eleven of the 19 AMCs regulated salesperson gifts to physicians, restricted salesperson access to facilities, and incorporated explicit enforcement mechanisms. For eight of these 11 AMCs, there was a significant change in prescribing. In contrast, there was a significant change at only one of eight AMCs that did not enact policies in all three areas.
The authors note study limitations, including that the observational design precludes proving causal relationships because other changes may have occurred that could have influenced the study results.
The researchers write that the reduction in the prescribing of detailed drugs and the increase in the prescribing of nondetailed drugs potentially represents a large reduction in costs. "In 2010, pharmaceutical companies earned more than $60 billion in revenues for detailed drugs included in the study, and generic drugs are on average 80 percent to 85 percent less expensive than brand-name drugs. A 1-percentage point change in market share could represent approximately a 5 percent relative change in revenue for the average detailed drug, suggesting that the observed changes in prescribing could have important economic implications."
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Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Related material: The editorial, "Reconsidering Physician-Pharmaceutical Industry Relationships," by Colette DeJong, B.A., and R. Adams Dudley, M.D., M.B.A., of the University of California, San Francisco, also is available at the For The Media website.
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