In a retrospective study of prescribing patterns among thousands of American ophthalmologists and optometrists, Johns Hopkins Medicine researchers concluded that ophthalmologists who receive even small financial incentives from pharmaceutical companies, such as free food, sponsored trips to meetings, or consulting fees are up to twice as likely to prescribe company-brand eye drops for glaucoma instead of cheaper generic versions.
“We don’t know why some clinicians more frequently prescribe high-priced brand name eye drops when generics are generally just as good,” says Thomas Johnson III, MD, Ph.D., Allan and Shelley Holt Rising Professor of Ophthalmology at Johns Hopkins University. University School of Medicine and Wilmer Eye Institute, which notes that the study was not designed to answer this question. “Perhaps frequent exposure to positive messaging about a drug is influencing this trend, or prescribers feel compelled, consciously or unconsciously, to demonstrate collegiality with pharmaceutical representatives.”
Other studies have shown that contributions from pharmaceutical companies – large and small – influence a wide range of treatment decisions, including eye injection choices for macular degeneration, an age-related eye disease.
The recently reported study focused on widely prescribed eye drops for glaucoma to reduce eye pressure and fluid buildup and to stop the blinding eye disease from worsening. More than 3 million Americans have the disease, according to the US Centers for Disease Control and Prevention. The drops are available in generic and branded versions and have similar side effects. Generic versions cost about half the price of branded versions and are just as effective, researchers say.
The study, described July 28 in JAMA Ophthalmology, was designed to assess the association between obtaining financial incentives from pharmaceutical companies and practitioners’ choice to prescribe brand-name glaucoma drops versus generic drops. The average annual amount paid to study group beneficiaries in 2018 was $65 (range: $24 to $147).
For the study, researchers looked at Centers for Medicare & Medicaid Services claims to find 26,038 eye care professionals who prescribed glaucoma drops in 2018. The group included 7,449 female and 18,589 male practitioners. of sight. Some 5,426 were optometrists and 20,612 ophthalmologists, including 1,103 glaucoma specialists.
Most of the group’s members (21,438) worked in urban areas.
On average, practitioners prescribed 1,778 days of glaucoma drops during the study period. Some 16,353 prescribers (63%) did not receive payments from manufacturers of branded eye drops.
Over the study period, drugmakers spent $5,060,346 in payments to practitioners who were part of the study, and 92% of those funds were spent on just 25% of participants.
Of the study group, 4,559 did not prescribe branded eye drops. Some 17,480 practitioners prescribed branded eye drops, but less than half the time. Another 3,999 practitioners prescribed branded eye drops more than half the time.
After further statistical analysis, the researchers concluded that practitioners receiving any amount of payment from a pharmaceutical company were 1.8 times more likely than practitioners receiving no payment to prescribe branded eye drops more than half the time.
Prescribers who received more payments—among the top 25% of recipients—were twice as likely to prescribe branded eye drops as practitioners receiving no payments.
According to the researchers, the link between payments and prescription of branded drops remained strong, even when excluding the top 5% and 1% of practitioners receiving payments. This suggests the link is not driven by a few “outlier” prescribers who received the most payouts, the researchers say.
Prescriber gender, urban area, and glaucoma specialty status were not associated with a higher frequency of brand name eye drops prescriptions.
“While some eye care professionals may say that small payments won’t influence their prescribing behavior, these data suggest otherwise,” says study co-author Gerard Anderson, Ph.D., professor of politics and health management at the Johns Hopkins Bloomberg School of Public Health.
Funding for the research was provided by the Johns Hopkins University School of Medicine, the National Eye Institute of the National Institutes of Health (K08EY031801), the Johns Hopkins Wilmer Eye Institute, the Allan and Shelley Holt Rising Chair, and Arnold Ventures.
Andrew Nguyen of Johns Hopkins and Kelly Anderson of the University of Colorado contributed to the statistical analysis and writing of this research.
Johnson has received non-financial support from Icare USA and grants from Perfuse Therapeutics and Injectsense.