The Physician Payment Sunshine Act (PPSA), a provision long-championed by Sens. Charles Grassley (R-IA) and Herb Kohl (D-WI) and contained within the Patient Protection and Affordable Care Act (PPACA), is intended to reduce the influence of industry's gifts to physicians by introducing mandatory transparency and reporting measures. But new research is questioning whether it will have any effect on physician prescribing habits.
Starting in 2012, drug companies who provide physicians with honoraria, gifts or other forms of payment will be required to disclose those gifts to the Centers for Medicaid and Medicare Services. The intent of the law is to reduce incentives for physicians to prescribe brand-name medications over equally-effective generic medications, which are often much cheaper for patients.
Legislators looking for affirmation of their bill's hypothesis may well be left wanting, say the authors of a new study published in the Archives of Internal Medicine.
"If the policymakers who passed these measures were hoping for a deterrent effect they may be disappointed," said the study's lead author, Genevieve Pham-Kanter, Ph.D., an assistant professor in the Department of Health Systems, Management and Policy at the Colorado School of Public Health.
Pham-Kanter's study looked at the effects of similar laws currently in place in Maine and West Virginia, and sought to understand their respective legislation's effects on the prescribing habits of doctors.
Pham-Kanter and fellow researchers looked at prescriptions dispensed for HMG-CoA reductase inhibitors (statins) and selective serotonin reuptake inhibitors (SSRIs), which they said were highly-substitutable and thus particularly prone to marketing efforts by industry. The states were then each compared with two demographically-similar states to control for general trends.
The researchers found West Virginia's legislation to have had "little to no" effect on physician prescribing habits. Maine exhibited a 0.8-5.3% reduction in branded statins compared to Rhode Island and New Hampshire, but prescribed 3.7% more SSRIs than New Hampshire.
"Our results show that the disclosure laws in the two states we examined had a negligible to small effect on physicians switching from branded therapies to generics and no effect on reducing prescription costs," said Pham-Kanter. "Transparency is important in its own right, but if deterring unnecessary, costly prescribing is a concern for policymakers, more direct action may be required."
Pham-Kanter did offer some caution about her research, saying accessing transparency information remained a "difficult and opaque" task, and "much information is not on-line yet." Further, while some similarities exist between Maine and West Virginia's sunshine laws and PPSA, they are not entirely the same. John Mack of Pharma Marketing Blog notes both Maine and West Virginia lack the public transparency and disclosure requirements contained within the PPSA, instead opting for disclosure to public officials instead. Had the information been more widely available, it is possible a greater impact would have been seen.
Archives of Internal Medicine - Effect of Physician Payment Disclosure Laws on Prescribing
New federal disclosure law may have little impact on drugs prescribed