O'Neill School of Public and Environmental Affairs, Indiana University, 1315 East Tenth Street, Bloomington, IN 47405, United States of America.
Department of Health Management & Informatics, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, United States of America.
J Subst Abuse Treat. 2019 Sep;104:104-115. doi: 10.1016/j.jsat.2019.06.014. Epub 2019 Jul 1.
Opioid use disorder (OUD) has become an increasingly grave public health concern, especially in the United States where approximately 80% of the global opioid supply is consumed. Despite greater awareness of the present overdose crisis, potentially life-saving OUD pharmacotherapy (medications for opioid use disorder or MOUD) utilization remains low. This study examines the extent of provider-directed marketing (detailing) for MOUD drugs and identifies any associations between a provider's receipt of detailing and their prescribing of MOUD drugs to Medicare Part D beneficiaries.
We combined Open Payments data on all provider-directed payments from pharmaceutical manufacturers with physician-level data on all MOUD prescriptions filled in Medicare Part D. We estimated the adjusted difference in Medicare days supply for all MOUD drugs (collectively) and separately for each MOUD drug that was associated with receipt of payments.
The Open Payments data show that $7.0 million MOUD-specific promotional payments were made by pharmaceutical manufacturers to 12,056 US physicians from 2014 to 2016, which is <1/6th of the $50.3 million made in overall non-MOUD opioid-related promotional payments to 76,992 US physicians during that same period. Prescribers who received any MOUD-specific payments prescribed 1080 daily MOUD-related doses per year more than peers who did not receive any MOUD-specific payments (p < 0.001). The data also show the relatively greater association between receipt of detailing and Suboxone prescriptions compared to Vivitrol.
Provider-directed marketing by MOUD manufacturers has been found to be significantly and positively associated with incidence of MOUD prescribing in Medicare Part D, as well as with the quantity of MOUD prescribed.
阿片类药物使用障碍（OUD）已成为日益严重的公共卫生问题，尤其是在美国，全球约 80%的阿片类药物供应都在美国被消耗。尽管人们对目前的过量用药危机有了更多的认识，但潜在的救命阿片类药物使用障碍药物治疗（治疗阿片类药物使用障碍的药物或 MOUD）的利用率仍然很低。本研究考察了提供者导向的营销（详述）MOUD 药物的程度，并确定提供者接受详述与他们向医疗保险 D 部分受益人开 MOUD 药物之间的任何关联。
我们将制药商针对所有提供者的定向支付的公开支付数据与医疗保险 D 部分中所有 MOUD 处方的医生级别数据相结合。我们估计了所有 MOUD 药物（总体）以及与支付相关的每种 MOUD 药物的医疗保险天数供应量的调整差异。
公开支付数据显示，2014 年至 2016 年，制药商向 12056 名美国医生发放了 700 万美元的 MOUD 专用促销付款，这不到同期向 76992 名美国医生发放的 5030 万美元的非 MOUD 类阿片相关促销付款的 1/6。接受任何 MOUD 专用付款的开处方者每年开出的 MOUD 相关剂量比未接受任何 MOUD 专用付款的开处方者多 1080 剂（p < 0.001）。数据还显示，与 Vivitrol 相比，接受详述与 Suboxone 处方之间的关联更为显著。
MOUD 制造商的定向营销与医疗保险 D 部分中 MOUD 处方的发生以及 MOUD 处方的数量呈显著正相关。
