March 15, 2018 Table of Contents 2 I. Study Objective and - - PowerPoint PPT Presentation

Possible Side Effects: Investigating the Connection Between Payments from Pharmaceutical Companies and the Prescribing Patterns of Physicians

March 15, 2018

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Table of Contents

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I. Study Objective and Executive Summary II. Rising Drug Costs III. Analysis IV. Study Results V. Largest Payers VI. Opioid Results

• VII. Physician Payments by Specialty
• VIII. Additional Resources

• I. CareDash uses newly available Medicare Part D data and demonstrated

correlations between payments to physicians and prescribing patterns

Executive Summary

• This study examines the correlation between payments to physicians for specific drugs and prescription habits for

those drugs using newly available prescription level data from the Centers for Medicare and Medicaid Services

• Our study identifies a strong financial relationship between pharmaceutical marketing tactics and physician

prescribing habits

• Correlations in this study indicate the likelihood that when doctors are paid for services such as speaking

engagements, consulting, etc., on behalf of a brand-name drug, they will prescribe that drug over a generic, or

• ther brand-name alternatives
• No previous study has done this across all providers and drugs
• The study found that physicians receiving a payment from a pharmaceutical for specific branded drug were 5x

more likely to be high prescribers of that drug

• Shockingly, this increased to nearly 14.5x for branded opioid drugs
• Variations can be seen by physician specialty type ranging from around 3x more likely for cardiologists to 7x more

likely for family medicine

When doctors received a payment for services such as speaking engagements and consulting, etc. on behalf of a brand-name drug, do they prescribe that drug over generic or other brand-name alternatives?

• Invoice spending on medicines was

$450B in 2016, expected to rise to $580B - $610B by 2021

• Brand-name drugs account for 72% of

all costs despite being just 10% of prescriptions

• For many brand-name drugs, generic

equivalents exist at greatly reduced prices

• II. Prescription drug costs are a massive contributor to our rising

healthcare costs, driven by branded drugs

Rising Drug Costs (2007-2016)

50 100 150 200 250 300 350 400 450 500 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Spending (Billions) Year

Net Spending Invoice to Net Difference

Source: QuintilesIMS, National Sales Perspective, Dec 2016; QuintilesIMS Institute

Representative Medicare Prescription Data Sample Representative Payments Data Sample

$6.2B total, payments to individuals range from $0 to $58.4M

Physician Profile ID Manufacturer or GPO Name Total Payment Amount (USD) Nature of Payment Drug Name Program Year 349191 Koven Technology, Inc. $107.40 Royalty or License Smartdop XT Vascular 2014 349191 FERA PHARMACEUTICALS, LLC $250.00 Consulting Fee Moxatag 2014 NPI Last Name First Name Drug Name Generic Name Beneficiaries Total Claims 1497998215 ELAM ISAAC HYDROCODONE-ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN 45 200 1811052285 GREENBERG ALEX VICODIN HYDROCODONE/ACETAMINOPHEN 12 14

• III. Our analysis joins payments to doctors with newly available Medicare prescriptions

data to create a fresh look at the impact of payments on prescribing patterns

Data contains over 800M prescriptions

Impact of Payments on Prescription Patterns

2014 2016

2015

2015

Payments occurring prior to prescriptions Payments occurring after prescriptions Payments in same year as prescriptions

5.25x

more likely to prescribe drug next year after receiving payment previous year

5.0x

more likely to prescribe drug if receiving payment the same year

5.48x

more likely to receive payment from drug company after prescribing in previous year

• IV. Providers receiving payments on behalf of a drug are around 5x more

likely to choose that drug over its alternatives

• V. Three companies gave over $100M to physicians from 2014 to 2016

$197.6M $167.3M $136.5M

• Xarelto
• Invokana
• Crestor
• Symbicort
• Botox
• Vraylar

Top Payment Categories 2014-2016

Top Pharmaceutical Payments by Company

• Royalty or license: $2.8B
• Promotional speaking or service: $1.7B
• Consulting: $1.2B

Payments Reported Key Drugs Company

• V. There was $185M in payments to physicians for just Xarelto, Invokana

and Humira from 2014 to 2016

Top Payments by Drug (2014 to 2016)

$76.5M $55.9M $53.0M Janssen Janssen Abbvie

Payments Reported Company Company

Top Branded Opioid Payments (2014-2016)

• VI. Physicians are 14.5x more likely to choose a specific opioid drug

when receiving payments

$16.0M $11.5M $5.7M

• Subsys (Fentanyl)
• Oxycontin
• Hysingla ER
• Nucynta

Payments Reported Key Drugs Company

From 2014 to 2016, there were $43M in payments to physicians directly associated with branded opioid drugs

• VI. The study showed variations in the correlations between payments and

prescribing patterns across specialties

Specialty Year of Payments 2014 2015 2016 Family Practice 5.95 5.57 6.99 Internal Medicine 4.7 4.27 4.93 Psychiatry 3.88 3.85 4.34 Cardiology 3.28 2.8 3.35

Increase in Likelihood of Prescription by Specialty Type (2014-16)

• The study also examined

correlations by physician specialty

• For example, Family Practice

physicians were 7 times more likely to receive a payment in 2016 after being high prescribers of a drug in 2015 Correlations by Specialty

For more information on “Possible Side Effects: Investigating the Connection Between Payments from Pharmaceutical Companies and the Prescribing Habits of Physicians” please visit: www.caredash.com/openpayments

• VII. Additional Resources

Healthcare Empowerment for All

Transparent Accessible Inclusive Empowering Convenient

CareDash is committed to making the healthcare experience more transparent for American consumers