Association Between Open Payments-Reported Industry Transfers of Value and Prostaglandin Analog Prescribing in the US

Abstract

Importance: Reported transfers of value (TOV) from pharmaceutical companies have been associated with greater use of branded anti-vascular endothelial growth factor 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 TOV and prescribing patterns. How these reported TOV are associated with prescribing patterns for prescription eye drops, not subject to the incentives created by Part B payments, should be considered.

Objective: To assess the association between prostaglandin analog (PGA) eye drop prescribing and reported nonresearch TOV by makers of branded PGAs to US vision care professionals.

Design, setting, and participants: This retrospective cohort analysis used a 20% nationally representative sample of 2018 Medicare Part D claims and industry TOV reported to the Open Payments program. Optometrists and ophthalmologists who had more than 10 claims for PGA drops in the 20% sample were analyzed. Analysis took place from June 2021 to February 2022.

Main outcomes and measures: Multivariable logistic regression assessing the association between membership in strata of reported TOV and branded PGA prescribing rate, controlling for prescriber demographic factors, local area practices, total PGA prescribing volume, and plan formularies involved.

Results: A total of 20 612 ophthalmologists and 5426 optometrists (7449 [29%] female and 18 589 [71%] male) prescribed PGA eye drops. Of these, 9685 (37%) were reported to have received TOV from manufacturers of branded PGAs in 2018, totaling $5 060 346. The median (IQR) reported TOV was $65 ($24-$147). Multivariable logistic regression showed that the predicted probability of primarily prescribing branded PGAs among prescribers who reported receiving no TOV was 12.9% (95% CI, 12.4%-13.4%). This figure increased to 19.6% (95% CI, 18.8%-20.4%) among prescribers receiving TOV, a 50% increase. There was a dose-response association, such that the top 10% of TOV recipients had a 29.2% probability (95% CI, 26.4%-31.9%) of preferential branded use.

Conclusions and relevance: While the median reported TOV to a PGA prescriber was relatively low in this study, there was a positive association between amount of reported nonresearch TOV received from PGA makers and the frequency of branded PGA use. This shows that small reported TOV were associated with differences in prescribing. High rates of branded PGA prescribing may pose a cost burden to patients that affects adherence. Clinicians and policy makers should be aware of these associations.

Figure 1.. Reported Transfers of Value (TOV) From Prostaglandin Analog Makers

Plots show median (IQR) reported TOV for prescribers with reported receipt of TOV in each category. Significance calculated by Wilcoxon rank sum test using Bonferroni correction. ^aP ≤ .001.

Figure 2.. Branded Prostaglandin Analog (PGA) Use

A, The absolute number of prescribers in each category for each level of branded PGA use, calculated as total days supplied of branded PGAs out of total days supplied of any PGA. B, The proportion of prescribers in each category for each level of branded PGA use.

Figure 3.. Association Between Industry-Reported Transfers of Value (TOV) and Branded Prostaglandin Analog Use

Points show estimated probability of using more than 50% branded prostaglandin analogs with 95% CIs when comparing membership in each reported TOV stratum to nonmembership while controlling for other variables. Est indicates estimated.

Figure 4.. Association Between Local Area Preferences and Individual Prescribing

Points show estimated marginal probabilities of using more than 50% branded prostaglandin analogs (PGAs) with 95% CIs at the quartiles of mean branded PGA use rates at the 3-digit zip code level. Est indicates estimated.