Drug companies have sophisticated marketing strategies designed to influence physicians’ prescribing habits. One way it often works: you visit your doctor for a health complaint. Near the end of your visit, he or she reaches inside a medicine cabinet and offers you a free drug sample. Patients love free samples. However, there really is nothing truly free in our health care system. That free drug sample is an expensive branded medication when it comes time to refill your prescription. Generic drugs are not available as free samples. Only branded drugs that drugmakers are trying to promote are. Samples are dropped off at doctors’ offices by drug company reps, who tell physicians about the drug. When offered a free sample I have advised people to also ask if there is a low-cost generic they may also try.
A few years ago, I spoke with Marshall Allen, a reporter at Pro Publica. Allen relayed a story about when a doctor gave him samples of a pain reliever that he later discovered had a list price of $3,252 a month. The kicker is the super expensive pain reliever was made from two common, over-the-counter drugs that are available for a small fraction of the $105 a day list price. I wrote about it here.
Doctors are sometimes compensated by drugmakers for the prescriptions they write to a given medication. According to research, payments to phsicians from drug companies are common and getting more frequent:
Many doctors in the United States receive payments from pharmaceutical companies, a recent study has found.The study indicated that these financial incentives have a significant impact on prescribing practices, leading to a higher frequency of brand-name drug prescriptions, costly medications and those produced by paying companies. The authors emphasized growing public concern over these payments as they contribute to rising drug costs for patients and healthcare systems.
>From August 2013 to December 2022:
- More than 57 percent of all physicians received at least one industry payment, totaling $12.13 billion.
- Among 22,937 hematologists/oncologists, nearly 75 percent received industry payments, amounting to $825,799,685 in total.
The study included industry payments for charitable contributions, consulting services, education, entertainment, food and beverages, gifts, grants, honoraria, speaker engagements and travel and lodging.
The cancer drug Keytruda was the drug most associated with industry payments to oncologists, the study found. The da Vinci robotic surgical system was the medical device most associated with industry payments. An industry study found that among elite oncologists (top 1%) the median industry payments were just short of $155,000 apiece. More than half of these oncologist physicians had held influential positions in the recent past.
Moreover, 84 of these physicians (60 percent) held or had previously held leadership positions in their hospitals, 33 (24 percent) served on journal editorial boards, and 29 (21 percent) held leadership positions in specialty associations over the past five years.
Drug company marketing is not as simple as getting paid, say, $100 for every prescription written for a super expensive drug. That would be illegal in most cases. The more sophisticated (legal) way to drive prescriptions without running afoul of antikickback statutes often takes the form of consulting agreements. Doctors who prescribe a particular drug are instructed to report back on how patients perform on it. Drugmakers do need feedback on recently approved drugs, but not all feedback is to merely amass patient data. There is a fine line between scientific collaboration and payola.
Another way drugmakers compensate physicians is speaking fees for presentations at conferences. The way this sometimes works is physicians who write enough prescriptions of a given drug are invited to present at a conference with free travel & lodging. These conferences could be in the Virgin Islands, Hawaii or on a cruise ship to the Bahamas. The presentation is prepared by drug company reps. A physician then presents information on drug outcomes for an hour on behalf of the drug company and the rest of the conference is theirs to enjoy with their family and sometimes a speaking fee.
An important question is: how much do these payments influence physicians? Doctors claim they are not influenced by payments. That is probably true much of the time. However, marketing costs drugmakers millions of dollars per year. If it had no effect drugmakers undoubtedly would stop paying for it.