(CN) – Policies that restrict direct pharmaceutical promotion to physicians lead to fewer prescriptions of brand-name drugs – with doctors opting to order generic versions instead, according to a new study published in the Journal of the American Medical Association.
Featured in the journal’s May 2 issue devoted to conflict-of-interest issues, the study reviewed prescription rates for promoted and non-promoted drugs at academic medical centers across the nation. The analysis included 16.1 million prescriptions.
Pharmaceutical companies often promote medications to doctors during events and sales visits that may include gifts such as free meals and samples, a practice known as “detailing.” While some academic medical centers have established policies that restrict detailing, it is unknown how such efforts actually impact prescribing practices.
“There has long been concern that drug marketing to physicians might influence their prescribing, including – and maybe especially – for psychiatric drugs,” said paper co-author Michael Schoenbaum, a senior adviser at the National Institute of Mental Health, part of the National Institutes of Health.
“Many policies have adopted policies to limit such marketing, and this study is one of the first to document what effect these policies actually have.”
Led by Ian Larkin at the University of California, Los Angeles, a multi-center team of researchers examined how such policies affected prescription rates at 19 academic medical centers in five states – California, Illinois, New York, Pennsylvania and Massachusetts. These states have the most doctors affiliated with academic medical centers, and accounted for nearly 35 percent of all U.S. prescriptions in 2015.
During the period of the study from January 2006 to June 2012, these academic medical centers established policies that restricted detailing during the period of the study. The paper compared prescription rates of 2,126 doctors at the 19 centers with those of 24,593 doctors with similar prescribing habits and backgrounds. The latter group was selected from a database of physicians in the same states.
The study reviewed eight major drug classes: antidiabetic agents, blood pressure medications, sleep aids, attention deficit hyperactivity disorder drugs, antidepressants, gastroesophageal reflux disease drugs, lipid-lowering drugs, and antipsychotic medications.
The team found that the average market share of detailed drugs across all eight classes in academic medical centers prior to the rollout of restriction policies was 19.3 percent. During the period reviewed for the study, the market share of detailed drugs decreased to 17.63 percent, an 8.7 percent overall decrease.
Meanwhile, the market share of non-detailed drugs increased 5.6 percent. The changes were statistically significant for six of the drug classes – and for all drugs in the aggregate – according to the authors.
There was a less significant decline in prescriptions of detailed drugs among the 24,593 doctors who were not subject to detailing restrictions.
Declines in detailed drug prescriptions were the greatest at academic medical centers with the strictest policies, including requirements for pharmaceutical-representative registration and training, bans on salespeople in patient-care areas, and penalties for policy violations.
However, the study also had limitations. The team did not find the policies caused the changes in prescribing, only that there was an association. The study also did not review the follow-through on detailing restrictions, and instead took policies at their word.
The team encourages future research to evaluate how detailing restrictions affect patients, rather than just measuring prescription rates.
“Important next steps include assessing the economic impact of these policies and whether they affect patients’ clinical outcomes,” Schoenbaum said.