Money and Prescribing: A Case Study in One American City

Interviewer: Laurie Scudder, DNP, NP; Interviewee: Susan F. Wood, PhD


August 14, 2017

An analysis of data reported to the AccessRx program in Washington, DC, which tracks pharmaceutical marketing expenses, found that expenditures for diabetes drugs were rising at a much higher rate than seemed warranted by diabetes prevalence.

What other factors could be contributing to this trend? Medscape spoke with Susan F. Wood, PhD, about a study examining the effect of pharmaceutical marketing on prescribing in the management of diabetes.

Medscape: Can you tell us about the AccessRx program? What kind of data are collected, and how do they differ from the information obtained through the national Open Payments system that was established as a result of the Physician Payments Sunshine Act of 2010?

Susan F. Wood, PhD

Susan F. Wood, PhD: AccessRx was a law passed in 2004 in the District of Columbia (Washington, DC). It was and remains one of the most innovative and novel laws around the country. In some ways, it was the predecessor of, but is broader than, the Physician Payment Sunshine Act that created the Open Payments system, a program with which healthcare professionals are more familiar. That law requires pharmaceutical companies to report to the federal government all payments made to physicians. The AccessRx law requires pharmaceutical companies to report marketing expenses to the DC government. This includes expenditures made to all healthcare providers, not just those made to physicians, and those expenditures include both advertising and detailing dollars (eg, money spent on staff detailers).

Although expenditures are reported to the District government, DC has a contract with researchers at George Washington University to analyze the data and issue annual reports. We do two types of reports: One annual report covers the funds spent on gifts to clinicians, the nature of the gifts, how much was spent on advertising and detailing, and how that has changed over time.

A second annual report looks at the impact of that money on healthcare in the District. That is very difficult to determine. Although we have information on marketing and advertising dollars, it's hard to draw conclusions. We have looked at a number of different topics over the years, including the report on diabetes that you referred to.

Two differences between the AccessRx law in DC and the national Open Payments system are important. The DC law requires confidentiality. We're not allowed to say which companies are involved, how much has been spent, or how much money they have given and to whom. The second point is that the DC law does not require the companies to report the medication or drug to which the gift is tied. So we can't tease out what product a company is marketing when they're detailing or making a payment to a physician or a nurse practitioner.

With Open Payments, the data are public and are linked to the product that is being marketed. Open Payments is a national reporting system, but it's limited to gifts to physicians and teaching hospitals. It does not capture advertising or detailing dollars, nor does it capture gifts to advanced practice clinicians (physician assistants, nurse practitioners, or pharmacists), which are captured in our data system.

We now have two parallel data collection systems going on. One is the publicly available, national Open Payments system that collects data on physicians in teaching hospitals and ties it to a particular marketed product. The other is a broader system, in which we capture payments to all health professionals as well as organizations, including detailing dollars, and we keep a tighter hold on specific payments to individuals and the companies providing those payments. AccessRx has more depth and breadth in terms of dollars spent in the District. We put those two data sets together when we're trying to examine the impact of these marketing dollars in the District.

Approximately $100 million is spent annually on marketing in the District. Most of that is spent on detailing, but tens of millions of dollars are spent on gifts to providers, organizations, and other entities that have an impact on healthcare in DC.


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