The Physician Payments Sunshine Act mandates public disclosure of payments from pharmaceutical and medical device companies to clinicians. While previous research shows these payments can influence prescribing habits, less is known about their impact on drug-device combinations like inhalers. These products involve both medication and a delivery device, often requiring clinician education and facing strong brand competition.
A recent study used Open Payments and Medicare data to examine whether payments to clinicians are associated with increased prescribing of manufacturer-specific inhalers. They identified clinicians who prescribed inhalers to Medicare beneficiaries in 2018–2019 and linked this data to manufacturer payments using National Provider Identifier numbers. The main focus was on general payments received in 2018 and their association with the number of manufacturer-specific inhaler days supplied in 2019.
The study used a hierarchical, two-part, zero-inflated negative binomial model to account for clinicians who did not prescribe any inhalers from a given manufacturer. Secondary analyses assessed whether higher payment amounts were associated with more prescribing, modelling payments both continuously and in quintiles. Sensitivity analyses included research payments and adjusted for outliers.
The study sample included 299,400 clinicians who prescribed inhalers in 2019, with 20% (51,978) having received at least one payment from an inhaler manufacturer in 2018. Among those receiving payments, 8.25% prescribed inhalers. Clinicians who received payments had higher overall prescribing activity, including more prescription claims, 30-day fills, and patients treated. Even when adjusted per patient, these clinicians had more inhaler claims and fills than those who did not receive payments.
In 2018, inhaler manufacturers made 2.16 million payments totalling $77.19 million to prescribers, with nearly all payments classified as general. Though research payments were rare (0.07%), they accounted for 14.1% of the total dollar amount. Median general and research payments were $50.33 and $21,955.87, respectively. Clinicians who received payments had more inhaler claims and 30-day fills, regardless of payment amount.
The primary analysis found that receiving any general payment was associated with 343 additional manufacturer-specific inhaler days supplied in 2019. This association held in sensitivity analyses, with a trimmed model showing an even greater increase (416 days). For every $100 in payments, clinicians prescribed approximately 2.5 more inhaler days. Higher payment quintiles were linked to significantly more days supplied, with the top quintile prescribing 1,634 additional days compared to the lowest.
About 20% of inhaler prescribers in 2018 received payments from inhaler manufacturers, and the study found a strong association between these payments and increased prescribing of the manufacturers’ inhalers the following year. A dose-response relationship was evident: larger payments were linked to greater prescribing, even at low payment amounts, such as those for meals. While causality cannot be confirmed, the findings align with previous research suggesting that industry payments influence prescribing behaviour.
The study highlights concerns that such payments, especially common small-value ones, may hinder the adoption of generics and value-based prescribing. The results reinforce the need for policy efforts to reduce industry influence and promote patient-centred care.
Source: AJRCCM
Image Credit: iStock
References:
Nadeem H, Donovan LM, Feemster LC et al. (2025) Association between Industry Payments and Prescription of Inhaled Medications. American Journal of Respiratory and Critical Care Medicine. 211(6).
