Industry Payments to Physicians Are Kickbacks. How Should Stakeholders Respond?
Open accessAbstract
Payments from the pharmaceutical industry to US physicians are common. In determining which payments rise to the level of an illegal kickback under the Anti-Kickback Statute (AKS), the Department of Health and Human Services' Office of Inspector General (OIG) has stated in nonbinding guidance that influencing or “swaying” physician prescribing is key. OIG has highlighted as a compliance standard the Pharmaceutical Research and Manufacturers of America Code on Interactions with Health Professions, which stipulates that permissible payments are those that do not interfere with prescribing. However, recent evidence has shown that most payments influence physician prescribing, driving higher prescription drug costs by increasing use of brand-name and low-value drugs. This evidence implies that many payments that are currently commonplace could be subject to prosecution under AKS. Given that these payments increase costs to patients and the health care system, there is a public interest in curtailing them. This article proposes a range of actions available to stakeholders—including industry, providers, regulators, and payers—to mitigate the cost-increasing effect of industry payments to physicians.
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Policies and legislation regulating physician interactions with pharmaceutical representatives show substantial heterogeneity across countries.
“However, relevant policies and legislations show substan tial heterogeneity across countries [252][253][254][255] .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [252]
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Physicians and the Pharmaceutical Industry
Wazana, A. D. (2000) · JAMA · doi:10.1001/jama.283.3.373 · Cited by 1,418 · see citing works
DeJong, C., Aguilar, T., Tseng, C., Lin, G. A., Boscardin, W. J., & Dudley, R. A. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.2765 · Cited by 518 · see citing works
The Effects of Pharmaceutical Firm Enticements on Physician Prescribing Patterns
Orlowski, J. P., & Wateska, L. P. (1992) · CHEST Journal · doi:10.1378/chest.102.1.270 · Cited by 386 · see citing works
Are Financial Payments From the Pharmaceutical Industry Associated With Physician Prescribing?
Mitchell, A. P., Trivedi, N. U., Gennarelli, R. L., Chimonas, S. C., Tabatabai, S. M., Goldberg, J., Diaz, L. A., & Korenstein, D. R. (2020) · Annals of Internal Medicine · doi:10.7326/m20-5665 · Cited by 262 · see citing works
Self-citationFollowing the Script: How Drug Reps Make Friends and Influence Doctors
Fugh‐Berman, A., & Ahari, S. B. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040150 · Cited by 235 · see citing works
Yeh, J. S.-J., Franklin, J. M., Avorn, J., Landon, J. E., & Kesselheim, A. S. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.1709 · Cited by 218 · see citing works
Types and Distribution of Payments From Industry to Physicians in 2015
Tringale, K., Marshall, D., Mackey, T., Connor, M., Murphy, J., & Hattangadi-Gluth, J. (2017) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.2017.3091 · Cited by 212 · see citing works
Are Gifts From Pharmaceutical Companies Ethically Problematic?
Brett, A. S., Burr, W., & Moloo, J. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.18.2213 · Cited by 136 · see citing works
Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs
Perlis, R. H., & Perlis, C. (2016) · PLoS ONE · doi:10.1371/journal.pone.0155474 · Cited by 115 · see citing works
Beyond Moral Outrage — Weighing the Trade-Offs of COI Regulation
Rosenbaum, L. R. (2015) · New England Journal of Medicine · doi:10.1056/nejmms1502498 · Cited by 98 · see citing works
Prescribers and Pharmaceutical Representatives: Why Are We Still Meeting?
Fischer, M. A., Keough, M. E., Baril, J. L., Saccoccio, L., Mazor, K. M., Ladd, E., Worley, A. V., & Gurwitz, J. H. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-009-0989-6 · Cited by 89 · see citing works
Physician Attitudes Toward Industry
Korenstein, D. R. (2010) · Archives of Surgery · doi:10.1001/archsurg.2010.75 · Cited by 85 · see citing works
Inoue, K., Blumenthal, D. M., Elashoff, D. A., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-031010 · Cited by 79 · see citing works
Health Industry Practices That Create Conflicts of Interest
Brennan, T. A., Rothman, D. J., Blank, L. L., Blumenthal, D., Chimonas, S. C., Cohen, J. J., Goldman, J., Kassirer, J. P., Kimball, H. R., Naughton, J., et al. (2006) · JAMA · doi:10.1001/jama.295.4.429 · Cited by 75 · see citing works
Sharma, M., Vadhariya, A., Johnson, M. L., Marcum, Z. A., & Holmes, H. M. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3043-8 · Cited by 73 · see citing works
Taylor, S. C., Huecker, J. B., Gordon, M. O., Vollman, D. E., & Apte, R. S. (2016) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2016.1678 · Cited by 67 · see citing works
Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia
Wood, S. F., Podrasky, J., McMonagle, M. A., Raveendran, J. A., Bysshe, T., Hogenmiller, A., & Fugh‐Berman, A. (2017) · PLoS ONE · doi:10.1371/journal.pone.0186060 · Cited by 66 · see citing works
Trends in Industry Payments to Physicians in the United States From 2014 to 2018
Marshall, D. C., Tarras, E. S., Rosenzweig, K. E., Korenstein, D. R., & Chimonas, S. C. (2020) · JAMA · doi:10.1001/jama.2020.11413 · Cited by 65 · see citing works
Mitchell, A. P., Winn, A. N., & Dusetzina, S. B. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.0776 · Cited by 59 · see citing works
Self-citationIndustry Payments to Physician Specialists Who Prescribe Repository Corticotropin
Hartung, D. M., Johnston, K. A., Cohen, D., Nguyen, T. D., Deodhar, A. A., & BOURDETTE, D. N. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.0482 · Cited by 54 · see citing works
Drug Diffusion through Peer Networks: The Influence of Industry Payments
Agha, L., & Zeltzer, D. (2022) · American Economic Journal Economic Policy · doi:10.1257/pol.20200044 · Cited by 50 · see citing works
US drug marketing: how does promotion correspond with health value?
Greenway, T., & Ross, J. S. (2017) · BMJ · doi:10.1136/bmj.j1855 · Cited by 49 · see citing works
Conflicts of Interest, Institutional Corruption, and Pharma: An Agenda for Reform
Rodwin, M. (2012) · Journal of Law, Medicine & Ethics · doi:10.1111/j.1748-720x.2012.00683.x · Cited by 48 · see citing works
Mitchell, A. P., Winn, A. N., Lund, J. L., et al. (2019) · The Oncologist · doi:10.1634/theoncologist.2018-0423 · Cited by 48 · see citing works
Self-citationZezza, M. A., & Bachhuber, M. A. (2018) · PLoS ONE · doi:10.1371/journal.pone.0209383 · Cited by 42 · see citing works
Drug Diffusion Through Peer Networks: The Influence of Industry Payments
Agha, L., & Zeltzer, D. (2019) · National Bureau of Economic Research · doi:10.3386/w26338 · Cited by 35 · see citing works
Khan, R., Nugent, C. M., Scaffidi, M. A., Gimpaya, N., & Grover, S. C. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.0999 · Cited by 34 · see citing works
PhRMA CODE ON INTERACTIONS WITH HEALTH CARE PROFESSIONALS
&NA; (2002) · Infectious Diseases in Clinical Practice · doi:10.1097/00019048-200203000-00011 · Cited by 31 · see citing works
Qian, J., Hansen, R. A., Surry, D. W., Howard, J. N., Kiptanui, Z., & Harris, I. (2017) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4224 · Cited by 26 · see citing works
Brunt, C. S. (2018) · Health Services Research · doi:10.1111/1475-6773.13064 · Cited by 26 · see citing works
Association Between Industry Payments to Physicians and Gabapentinoid Prescribing
Rhee, T. G., & Ross, J. S. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.1082 · Cited by 26 · see citing works
Inoue, K., Figueroa, J. F., DeJong, C., Tsugawa, Y., Orav, E. J., Shen, C., & Kazi, D. S. (2021) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.120.007521 · Cited by 24 · see citing works
Drug Firms' Payments and Physicians' Prescribing Behavior in Medicare Part D
Carey, C. M., Lieber, E. M. J., & Miller, S. (2020) · National Bureau of Economic Research · doi:10.3386/w26751 · Cited by 24 · see citing works
In Defense of Industry-Physician Relationships
Nakayama, D. K. (2010) · The American Surgeon · doi:10.1177/000313481007600935 · Cited by 23 · see citing works
Trends and Characteristics of US Medicare Spending on Repository Corticotropin
Hartung, D. M., Johnston, K. A., Leuven, S. V., et al. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.3631 · Cited by 23 · see citing works
Industry Payments to Physicians and Prescriptions of Brand‐Name Proton‐Pump Inhibitors
Morse, E., Fujiwara, R. J. T., & Mehra, S. (2018) · Otolaryngology · doi:10.1177/0194599818803337 · Cited by 23 · see citing works
The relation between promotional spending on drugs and their therapeutic gain: a cohort analysis
Lexchin, J. (2017) · CMAJ Open · doi:10.9778/cmajo.20170089 · Cited by 22 · see citing works
Cole, A. L., Wood, W. A., Muluneh, B., et al. (2020) · JCO Oncology Practice · doi:10.1200/jop.19.00301 · Cited by 21 · see citing works
The Association between Industry Payments and Brand‐Name Prescriptions in Otolaryngologists
Morse, E., Hanna, J. M., & Mehra, S. (2019) · Otolaryngology · doi:10.1177/0194599819852321 · Cited by 12 · see citing works
Kickbacks, Self-Referrals, and False Claims
Krause, J. H. (2013) · CHEST Journal · doi:10.1378/chest.12-2889 · Cited by 10 · see citing works
Singh, P., Forman, H. P., Adamson, A. S., et al. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4698-x · Cited by 10 · see citing works
Do We Need Stronger Sanctions to Ensure Legal Compliance By Pharmaceutical Firms?
Rodwin, M. A. (2015) · PubMed · Cited by 7 · see citing works
Conflict of Interest in the Pharmaceutical Sector: A Guide for Public Management
Rodwin, M. A. (2019) · Digital Commons-DePaul (DePaul University) · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice. 2009. Conflict of Interest in Medical Research, Education, and Practice. Edited by Lo Bernard and Field Marilyn J.. The National Academies Collection: Reports Funded by National Institutes of Health. Washington (DC): National Academies Press (US). http://www.ncbi.nlm.nih.gov/books/NBK22942/. 20662118
Cited by
Sorted by citations
Galderisi, S., Appelbaum, P. S., Gill, N., Gooding, P., Herrman, H., Melillo, A., Myrick, K., Pathare, S., Savage, M., Szmukler, G., et al. (2024) · World Psychiatry · doi:10.1002/wps.21230 · Cited by 76 · see citing works
- Authors
- Mitchell, A., Sarpatwari, A., & Bach, P. B.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Harvard University (US)
- Delfi Diagnostics
- Corresponding author
- Mitchell, Aaron
- Venue
- Journal of Health Politics, Policy and Law
- Publisher
- Duke University Press
- Published
- 2022-07-14
- Volume
- 47
- Issue
- 6
- Pages
- 815-833
- ISSN
- 0361-6878 (ISSN-L)
- 1527-1927
- PMC
- PMC11107028
- OpenAlex
- W4286563759
- Cited by
- 16
- References
- 43
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 3 · 2023: 4
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Health Politics Policy and Law (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (P30CA008748)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- kickbacks, anti-kickback statute, prescription drug costs, low-value prescribing, health care cost containment, industry compliance
- MeSH terms
- Drug Industry, Humans, Physicians, United States, Prescription Drugs
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