College of Pharmacy, Oregon State University, Corvallis.
Oregon Health & Science University, Portland.
JAMA Netw Open. 2018 Jun 1;1(2):e180482. doi: 10.1001/jamanetworkopen.2018.0482.
Despite great expense and little evidence supporting use over corticosteroids, prescriptions for repository corticotropin (H. P. Acthar Gel; Mallinckrodt Pharmaceuticals) have increased markedly. Aggressive sales tactics and payments from the manufacturer may influence prescribing behavior for this expensive medication.
To characterize industry payments to physician specialists who prescribe corticotropin in the Medicare program.
DESIGN, SETTING, AND PARTICIPANTS: This study was a cross-sectional analysis of Centers for Medicare & Medicaid Services 2015 Part D prescribing data linked to 2015 Open Payments data. Nephrologists, neurologists, and rheumatologists with more than 10 corticotropin prescriptions (frequent prescribers) in 2015 were included.
Frequency, category, and magnitude of corticotropin-related payments from Mallinckrodt recorded in the Open Payments database.
Frequency, category, and magnitude of corticotropin-related payments from Mallinckrodt, as well as corticotropin prescriptions and expenditures for Medicare beneficiaries.
Of the 235 included physicians, 65 were nephrologists; 59, neurologists; and 111, rheumatologists. A majority of frequent corticotropin prescribers (207 [88%]) received corticotropin-related payments from Mallinckrodt. The median (range) total payment for 2015 was $189 ($11-$138 321), with the highest payments ranging from $56 549 to $138 321 across the specialties. More than 20% of frequent prescribers received more than $10 000 and the top quartile of recipients received a median (range) of $33 190 ($9934-$138 321) in total payments per prescriber. Payments for compensation for services other than consulting contributed the most to the total amount. Mallinckrodt payments were positively associated with greater Medicare spending on corticotropin (β = 1.079; 95% CI, 1.044-1.115; P < .001), with every $10 000 in payments associated with a 7.9% increase (approximately $53 000) in Medicare spending on corticotropin. There was no association between corticotropin-related payments and spending on prescriptions for synthetic corticosteroids.
In this study, most nephrologists, neurologists, and rheumatologists who frequently prescribe corticotropin received corticotropin-related payments from Mallinckrodt. These findings suggest that financial conflicts of interest may be driving use of corticotropin in the Medicare program.
尽管repository corticotropin（H. P. Acthar Gel；Mallinckrodt Pharmaceuticals）的使用费用高昂，且几乎没有证据支持其使用，但开给这种皮质激素的处方数量却显著增加。厂家的积极销售策略和付款可能会影响这种昂贵药物的处方行为。
描述开给皮质激素的医生专家的行业支付情况，这些医生在医疗保险计划中开了皮质激素处方。
设计、环境和参与者：本研究是对医疗保险和医疗补助服务中心 2015 年处方数据与 2015 年开放支付数据进行的横断面分析。纳入了 2015 年开皮质激素处方超过 10 次的肾脏病专家、神经科医生和风湿病医生（频繁开方者）。
从开放支付数据库中记录的 Mallinckrodt 与皮质激素相关的支付频率、类别和金额。
Mallinckrodt 与皮质激素相关的支付频率、类别和金额，以及医疗保险受益人的皮质激素处方和支出。
在 235 名被纳入的医生中，65 名为肾脏病专家，59 名为神经科医生，111 名为风湿病医生。大多数频繁开皮质激素处方的医生（207 [88%]）收到了 Mallinckrodt 的皮质激素相关支付。2015 年的总支付中位数（范围）为 189 美元（11 美元至 138321 美元），各专业的最高支付金额从 56549 美元到 138321 美元不等。超过 20%的频繁处方者收到了超过 10000 美元的款项，而收入最高的四分之一的人在每位医生的总支付中收到了中位数（范围）为 33190 美元（9934 美元至 138321 美元）。除咨询费以外的其他服务补偿支付对总金额的贡献最大。Mallinckrodt 的支付与皮质激素在医疗保险中的支出呈正相关（β=1.079；95%CI，1.044-1.115；P<0.001），每 10000 美元的支付与皮质激素在医疗保险中的支出增加 7.9%（约 53000 美元）相关。皮质激素相关支付与合成皮质激素处方的支出之间没有关联。
在这项研究中，大多数经常开皮质激素处方的肾脏病专家、神经科医生和风湿病医生都从 Mallinckrodt 获得了皮质激素相关的支付。这些发现表明，经济利益冲突可能是皮质激素在医疗保险计划中使用的驱动因素。
