Pharm Exec's 17th annual listing again features data provided by biopharma market intelligence firm Evaluate Ltd.

Quiz Ref ID Limitations of the Open Payments data include minimal prerelease vetting by physicians, 2 nonreported payments (including free drug samples and patient education materials), limited information about the accuracy of the data, and deidentified and disputed payments, which were excluded. The methods used in this study could be applied to other payment types, to drugs with varying degrees of generic competition and cost-effectiveness, and to brand-name drugs that compete within the same class. 1 , 3 , 5 Although voluntary guidelines from the Pharmaceutical Research and Manufacturers of America allow meals and gifts to physicians of up to $100 in value, 39 our findings indicate that even payments of less than $20 are associated with different prescribing patterns.

If events where industry-sponsored meals are provided affect prescribing by informing physicians about new evidence and clinical guidelines, then the receipt of sponsored meals may benefit patient care. As compared with the receipt of no industry-sponsored meals, we found that receipt of a single industry-sponsored meal, with a mean value of less than $20, was associated with prescription of the promoted brand-name drug at significantly higher rates to Medicare beneficiaries. We linked 2 national data sets to quantify the association between industry payments and physician prescribing patterns.

Receipt of costlier meals was significantly associated with increased target-drug prescribing for all drugs except desvenlafaxine, with ORs ranging from 1.02 to 1.13 (eTable 3 in the Supplement ). The interaction between mean cost per meal and number of days receiving sponsored meals was also significant for all drugs except desvenlafaxine, but the interaction effects were too small to be qualitatively meaningful (data not shown). The remaining 5% of payments promoting the target drugs included speaking fees, honoraria, travel expenses, and education (such as providing free textbooks or journal articles); physicians receiving these nonmeal payments were excluded from the regression analysis. The study population included 279 669 physicians (eFigure in the Supplement ). Of these, 155 849 physicians wrote more than 20 prescriptions in 1 of the 4 target drug classes and were assigned to study groups.

For each physician, relative rates of prescribing a target drug were calculated as a percentage of that physician's total Medicare Part D prescriptions in the drug category in 2013. We limited our regression analysis to the 91% to 99% of physicians in each group whose only payments related to target drugs were for meals, excluding those who received other types of payment, such as research grants, consulting, and royalties. Because meals were often reported as multiple small food payments on the same day, our primary measure of industry contact was number of days receiving a meal related to the promotion of a target drug during the 5-month study period.

We used physician name and location to link each physician's payments with his or her prescription records, and excluded physicians with identical matching criteria to avoid inadvertently matching 1 physician's prescribing records with another physician's payment records.

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