Research Letter
November 7, 2024
Industry Payments to Physicians by Competing Manufacturers Within Novel Therapeutic Classes
Q. Wilton Sun, Joseph S. Ross
JAMA. 2024;332(24):2111-2113. doi:10.1001/jama.2024.20842
Pharmaceutical manufacturers make extensive payments to physicians for marketing purposes, including for speaking, travel, attending promotional events, and consulting arrangements,1,2 with well-documented influence on prescribing practices.3 The competitive dynamics among manufacturers launching new products within the same therapeutic class, reflected in their promotional payments to physicians, remain unclear. We analyzed patterns of industry payments associated with new agents entering 6 novel therapeutic classes, assessing the extent and persistence of payments to physicians from competing manufacturers following receipt of payment from manufacturers of first-in-class products.
Methods
This cross-sectional study analyzed nonresearch, nonroyalty general payments from industry to physicians made between August 2013 and December 2022 from the Open Payments database, which includes information on the product associated with the payment. We restricted analyses to payments associated with the following therapeutic classes: interleukin 17 (IL-17), IL-23, programmed cell death protein 1 (PD-1), programmed death ligand 1 (PD-L1), proprotein convertase subtilisin/kexin type 9 (PCSK-9), and sodium-dependent glucose transporter 2 (SGLT-2) inhibitors. These classes were selected because all represented novel therapeutic advances wherein the first product launched after August 2013—the inception date of Open Payments—with demonstrated clinical effect,4-6 multiple competing manufacturers entering the market shortly afterward, and large market uptake.
We restricted analyses to physicians who received payments associated with the first-in-class product in the calendar year prior to market entry of any competing product. Our primary outcome was the cumulative number of these physicians who subsequently received payments associated with products from competing manufacturers in the first 5 years of market entry, and the proportion of these manufacturers’ payments that went to these physicians, calculated using descriptive statistics.
Analyses were performed in R Studioversion 4.2.1. In accordance with the Common Rule, this study was exempt from review and informed consent because it was based on publicly available information. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
Results
There were 4624 physicians who received any nonresearch, nonroyalty payments associated with the first-in-class IL-17 product in the calendar year prior to market entry of any competing product, 1890 for the IL-23 product, 935 for the PD-1 product, 3489 for the PD-L1 product, 16 072 for the PCSK-9 product, and 40 820 for the SGLT-2 product (Table 1). The proportion of physicians receiving payments from competing manufacturers increased over the first 5 years after competing products launched (Table 1); proportions of physicians paid were highest for risankizumab (n = 1462 [77.4%]) and lowest for inclinsiran (n = 348 [2.2%]) in year 1, while proportions were highest for evolocumab (n = 14 036 [87.3%]) and lowest for ertugliflozin (n = 17 430 [42.7%]) by year 5. The proportion of competing manufacturers’ payments to these physicians declined over this period (Table 2); proportions of payments were highest for ixekizumab ($2 483 923 [84.1%]) and lowest for dostarlimab ($881 [9.4%]) in year 1, while proportions were highest for brodalumab ($65 549 [71.3%]) and lowest for cemiplimab ($674 051 [17.7%]) by year 5.
Discussion
This study demonstrated that between 40% and 90% of physicians already receiving payments from manufacturers of 6 first-in-class agents received payments from competing manufacturers by the fourth to fifth year following subsequent approvals. Competing manufacturer payments persisted throughout the 5 years, although the proportion of total payments received by these physicians declined. The variability in payments may reflect differences in marketing strategies, therapeutic indications, and heterogenicity of prescribers across competing agents and therapeutic classes.
This study is limited to 6 novel therapeutic classes with first-in-class launches after 2013. In addition, analyses were based on calendar year, regardless of competing product approval date, potentially limiting payment numbers for products launched late in a calendar year. Moreover, it is unclear why first-in-class and competing manufacturers selected these physicians who initially received payments, including whether they were high-volume prescribers or key opinion leaders. Nevertheless, these findings suggest that industry-physician financial relationships are likely a strategic aspect of competing manufacturers’ promotional effort for product launches within therapeutic classes. Physician professional societies may consider providing guidance regarding these financial relationships in the context of product competition within therapeutic classes.
