Friday, January 25, 2008

Bribing Physicians: Where My Money At?

An utterly fascinating article in the Wall Street Journal by Vanessa Fuhrmans notes that insurers are moving to bribe doctors for prescribing generics. Snippet below, but you really should read the whole article.

Health plans are drawing scrutiny for offering financial incentives to entice doctors to prescribe cheaper generic medicines, including paying doctors $100 each time they switch a patient from a brand-name drug.

Pharmaceutical companies have long gone to great lengths to try to get doctors to prescribe their brand-name pills. They spend billions of dollars, plying physicians with samples, educational lunches and speaker fees. But as the patents for a growing number of blockbuster medicines expire, some health insurers are trying to trump those perks with bonuses or higher reimbursements for writing more generic prescriptions.

The idea, health plans say, is to save everyone -- patients, employers and insurers -- money. And many doctors argue that it's only right to reimburse them for spending time evaluating whether a cheaper generic alternative is better or as good for a patient.

But the more aggressive approaches, such as cash rewards for each patient switched from a given list of drugs, are coming under fire for injecting financial incentives into what some patient advocates and legislators say should be a purely medical decision. Medical societies are also concerned that such rewards may put doctors in the ethically questionable position of taking a payment that patients know nothing about.

There is little doubt that many newer medications offer little to no benefit over generics and this site and others have frequently noted that prescription practices often appear quite irrational. In psychiatry, for example, the movement to place everyone on Depakote and/or atypical antipsychotics for treating bipolar disorder was a marketing miracle considering that the evidence base never showed superior efficacy relative to lithium. The same story goes for treating schizophrenia with atypical antipsychotics over conventional antipsychotics (as well as ignoring psychosocial interventions) based on a set of obviously flawed studies. Or treating depression with newer antidepressants rather than generics or (especially) with psychotherapy, which is generally linked to better long-term outcomes.

Of course, as has been documented here and many other places, we know that Big Pharma utilizes a variety of methods to ensure that physicians prescribe newer drugs, even if such prescriptions are irrational. If we just consider this as a battle of mega-industries who want to maximize their profits (Pharma vs. Insurance), then maybe this is the unfettered free market at its best?

On one hand, we have Pharma using a variety of tricks, including: buying meals, providing all sorts of gifts, infomercials disguised as medical education, tricky statistics, burying negative findings, and just being sooooo good looking, and on the other we now have insurers providing kickbacks to doctors for prescribing generics. Both pharma and insurers are attempting to influence prescribing through methods far outside of providing objective medical information to physicians. I know that some favor a pure free market approach and if so, then I suppose that this is just the latest and greatest maneuver in which companies attempt to pimp their wares (Pharma) or buy physician loyalty to a different set of products (Insurers).

As for the patients, um, who is looking out for their interests? I realize that physicians genuinely want their patients to improve (well, maybe not this one), but is a system of competing interests trying to irrationally manipulate physicians' prescribing practices really the best way to ensure patient wellness?

By the way, how much $$$ could insurers save? See below.
Hat Tip: PharmaGossip

To sum up the current state of affairs in four words: Dolla Dolla Bill Y'All


Anonymous said...

Haven't had a look at this site for a long time.

Glad to see you questioning the validity of prescribed drugs and the reasons why.

As someone who has had more shrinky drugs than hot dinners (well maybe not but heading in that direction) I question what is being done in the name of 'recovery'.

The only prescribed drug that has ever hit the spot. Done what is says on the packet is Lorazepam. Yep, I know the addictive nature of it. But rather than having off pat comments about that why don't the pharma companies work on making a non addictive lorazepam. In fact why don't they work on developing all shrinky drugs that don't have addictive side effects.Cos from people I know, who take them, it is a nightmare trying to come off Prozac and Seroxat.

Would be interested to know your views on the addiction angle and also get more info on what the pharma companies are really up to.

Let us have some real evidence based research out here.

Anonymous said...

I love your blog!

The story inside PBMs and insurers is not how much they can save by getting everyone onto generics, but how much they can MAKE. It is ungodly amounts of profits for them to push drugs in general, but especially generics. The moneys they spend promoting pills (marketing, incentives, disease management, P4P initiatives, paying members to take health risk assessments, etc.) is nothing compared to their profits.

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