AIM: Sunshine laws dont change physician prescribing
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Kavita Nair, PhD, of the clinical pharmacy department in Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado Anschutz medical campus in Aurora, and colleagues wanted to explore the effect of regulations within the Patient Protection and Affordable Care Act that require pharmaceutical companies to disclose some payments made to physicians, such as honoraria, fees for consulting services or travel expenses. The provisions were designed to add transparency to such transactions.
Nair and colleagues hypothesized that Sunshine laws act as a deterrent, compelling physicians to prescribe less of branded drugs. To test their hypothesis, they looked at two states—Maine and West Virginia—that had enacted sunshine laws in 2004 and compared them with demographically similar states that had no such laws. For Maine, the comparator states were New Hampshire and Rhode Island. For West Virginia, they were Kentucky and Delaware. The researchers selected statins and SSRIs, two classes of pharmaceuticals that are aggressively marketed and can be substituted with clinically and pharmacologically similar therapies.
They used the Thomson Reuters Marketscan Claims and Encounters Database to obtain claims data on employer-insured patients between July 2003 and March 2009 and state demographic data from the 2002 U.S. Census, as well as FDA drug data.
They found that Maine’s sunshine law had a negligible effect on branded statin and SSRI prescribing, with reductions for statins of less than a percentage point compared with New Hampshire and 5.3 percentage points compared with Rhode Island. SSRI prescribing increased by 3.73 percentage points compared with New Hampshire and decreased by less than a percentage point compared with Rhode Island.
In West Virginia, the there was a 0.26 percentage point and 1.09 percentage point increase in prescribing for branded statins and SSRIs, respectively, compared with Kentucky and a 2.62 percentage point and 0.53 percentage point decrease compared with Delaware.
“Overall, our results suggest that the Physician Payments Sunshine Provision in the federal healthcare law may have a limited effect on prescribing and on expenditures,” they wrote.
They speculated that the required reporting systems may be a factor if the systems failed to capture promotional efforts that influence physician prescribing. The authors added that payment disclosures, while reported to state agencies, are not disseminated to the public, which may dilute the expected deterrent effect.
Among study limitations, they pointed out that the patients were insured through employers and may not be representative of all patient populations and that the comparator states may differ in non-demographic ways from the two states with sunshine laws.