Makers of Antipsychotics Targeting Medicaid Psychiatrists

Deborah Brauser

October 03, 2012

October 3, 2012 — Manufacturers of antipsychotic medications are targeting high levels of their marketing dollars toward psychiatrists in the Washington, DC, area, with a special emphasis on those who are Medicaid prescribers, new research suggests.

The study was conducted by researchers from the George Washington University School of Public Health and Health Services (SPHHS), with results released in a report by the DC Department of Health (DOH).

The investigators found that in 2010, more than $25 million was spent on marketing antipsychotics in the DC area and that 15% of the District physicians who received at least $1000 in gifts from these manufacturers were psychiatrists. Of the area's psychiatrists who accepted Medicaid, 35% were found to have received gifts of some type from the top manufacturers of antipsychotics.

In addition, the most recent data available on use showed that almost 10% of Medicaid recipients in the area received a prescription for antipsychotics in 2008, which is more than 5 times higher than the prescription rate for the total national population.

"In looking at data provided by the Centers for Medicare and Medicaid Services, we were surprised to learn how very high these prescription rates were for people in the District," lead researcher Susan Wood, PhD, associate professor in the Department of Health Policy and the Department of Environmental and Occupational Health at SPHHS, told Medscape Medical News.

Dr. Susan Wood

"Even taking other factors into account, this seems disproportionately high and certainly identifies a problem," said Dr. Wood.

However, she stressed that they only examined where pharmaceutical marketing dollars were spent — and did not have data showing that the clinicians who received gifts were high prescribers of antipsychotics.

"We know the vast majority of prescribers want to do the best by their patients. And recognizing the marketing strategies that are being used can help to steer clear of them," said Dr. Wood.

The report was released September 26 and is available on the DC DOH Web site.

Public Disclosure

"The report is in fulfilment of AccessRx, the District of Columbia's law requiring public disclosure of pharmaceutical marketing expenditures spent on all healthcare providers by every pharmaceutical company that markets in the District," according to a release from the SPHHS.

"Pharmaceutical marketing efforts that encourage the use of new, expensive drugs when other alternatives may be safer, more effective, and more affordable complicate decision-making for prescribers, patients, and payers," states the new report.

The authors note that sales representatives from pharmaceutical companies may downplay adverse events and encourage prescribing that is not supported by scientific evidence or by approval from the US Food and Drug Administration.

"Industry marketing methods" were defined as visits from these sales reps, the hiring of physicians as consultants or speakers, the distribution of gifts and free samples, and the funding of medical and patient organizations or of continuing medical education.

A report from the DC DOH released in 2009 looked broadly at these topics. The new report was commissioned to also include use of antipsychotics in children.

"Much of the increase in antipsychotic prescriptions is due to off-label prescribing for conditions other than schizophrenia, bipolar disorder, or autism, the indications for which second-generation antipsychotics are currently approved," write the researchers.

Raises Questions

Data analysis showed that 9.8% of Medicaid beneficiaries in the DC area received antipsychotics in 2008. Only an estimated 1.2% of the entire US population filled prescriptions for these medications in 2005.

"While it is likely that the Medicaid population has higher rates of mental disorders than the whole population, it is worth questioning whether 1 in 10...should be taking potent antipsychotics with serious risks," write the report authors.

They note that the only states with higher rates of antipsychotic prescriptions in 2008 were Oregon (10.8%) and Maryland (10.1%). The lowest rates were found in New Mexico (0.6%), Michigan (2.0%), and California (2.7%)

A total of 119 DC psychiatrists accepted Medicaid in 2012. Of these, 42 received gifts from antipsychotic manufacturers in 2010; 56 received such gifts in 2008.

Although the number of clinicians receiving gifts declined, the total value of the gifts increased from approximately $260,000 in 2009 to more than $340,000 in 2010.

"This is very disturbing. We can't say who exactly is doing the prescribing, but definitely the manufacturers are giving more money and gifts to psychiatrists who have Medicaid patients than to those who do not," said Dr. Wood.

"Prescribing decisions can have a profound effect on both state coffers and population health," she added in a release.

Final Recommendations

Based on study findings, recommendations listed in the report include the following:

  • Improve transparency by amending the AccessRx Act to make publicly available all pharmaceutical-marketing reports;

  • Require gift expenditure reports to include "unique recipient identifiers";

  • Notify and warn healthcare providers who receive large sums about the appearance of potential conflicts of interest;

  • Study data patterns to identify potentially irrational prescribing practices;

  • Increase prescriber education, with a specific focus on antipsychotic use in children; and

  • Consider legislation, such as found in Vermont, to ban all gifts to healthcare providers.

"With greater transparency and more education to counterbalance pharmaceutical marketing efforts, more District residents — including some of our most vulnerable — will be able to enjoy trusting patient-provider relationships and choose treatments with risk and benefits appropriate for their health," write the report authors.

Dr. Wood noted that although their overall data were specific for DC, their findings are generizable to clinicians throughout the United States.

"It's important for prescribers to know that what is happening here is likely happening around the nation as well," she concluded.

Impacts of Pharmaceutical Marketing on Healthcare Services in the District of Columbia: Focus on Antipsychotics in Children. Published September 26, 2012. Full report