Financial incentive plays a role in optometric prescribing habits. Photo: Getty Images.

Many physicians interact with and have positive perceptions of pharmaceutical sales representatives, and from them, physicians receive “transfers of value” (including meals, travel fees, speaking fees and gifts, all discrete from research support) and information about branded drugs and their use. Previous studies have found that information provided without transfers of value, as in industry-sponsored continuing medical education events, is associated with higher branded drug use. A recent review in JAMA Ophthalmology determined that recipients of such largesse were more likely to prescribe branded prostaglandin analogs, even though the transfer of value median was relatively low at $65.

The retrospective cohort analysis used a 20% nationally representative sample of 2018 Medicare Part D claims and industry transfers of value reported to the Open Payments program. The Open Payments program requires manufacturers of drugs, medical devices and medical supplies to report their payments and transfers of value to the Centers for Medicare & Medicaid Services.

The researchers noted a total of 20,612 ophthalmologists and 5,426 optometrists (29% female, 71% male) prescribed prostaglandin analog eye drops. Of these two groups, 37% were reported to have received transfers of value from manufacturers of branded prostaglandin analogs in 2018, totaling $5,060,346. The median reported transfers of value was $65. Multivariable logistic regression showed that the predicted probability of primarily prescribing branded prostaglandin analogs among prescribers who reported receiving no transfers of value was 13%. This figure increased to 20% among prescribers receiving transfers of value. There was a dose response association, such that the top 10% of transfers of value recipients had a 29% probability of preferential branded use.

“Reported transfers of value from pharmaceutical companies have been associated with greater use of branded anti-VEGF agents by ophthalmologists, but payment under the Medicare Part B buy-and-bill model includes a financial incentive to choose costlier agents, potentially confounding analyses of pharmaceutical transfers of value and prescribing patterns,” the researchers wrote in their paper. “High rates of branded prostaglandin analog prescribing may pose a cost burden to patients that affects adherence and worsens outcomes.”

While the researchers could not determine the motivations of clinicians who frequently prescribe branded prostaglandin analogs or the reason why they prescribe patients a branded prostaglandin analog, reported receipt of industry transfers of value does seem to be an important factor associated with branded prostaglandin analog use. The dose response association suggested that the magnitude of transfers of value matters, but the relatively low value of typical reported transfer of value suggests monetary gain is not the sole or even primary driver of this association.

“Still, for optometrists and ophthalmologists who care for patients with glaucoma, the results of this study suggest a need to revisit policies and attitudes regarding industry interaction,” the researchers concluded.

Nguyen AM, Anderson KE, Anderson G, Johnson TV. Association between open payments-reported industry transfers of value and prostaglandin analog prescribing in the US. JAMA Ophthalmol. July 28, 2022. [Epub ahead of print].