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Physician Interactions With Industry: Striking the Right Balance.

The Open Payments database, required pursuant to the Physician Payment Sunshine Act (Sunshine Act), was created as part of the passing of the Patient Protection and Affordable Care Act implemented in 2010. The Open Payments database is the most comprehensive source of industry payments to physicians to date. Prior to the first Open Payments data being reported for a portion of calendar year 2013, and annually thereafter, several drug and device manufacturers reported these payments and other transfers of value either voluntarily, under court order, or under state-specific legislation. Under the Sunshine Act, manufacturers of covered drugs, devices, biologics, and medical supplies must report payments and other transfers of value to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS). CMS provides teaching hospitals and physicians the opportunity to review and dispute the data, and thereafter makes it publicly available via the Open Payments site. Many published reports trend this publicly available data, both before and following the first report of the Open Payments data. These analyses show that physician characteristics associated with higher payments have been identified, and include gender, years in practice, medical school, institution, and specialty.45 Furthermore, with these data and other publicly available data sources, such as Medicare Part D prescribing data, many researchers have been able to identify associations between payments and prescribing patterns.67 Other analyses conclude that industry payments are associated with more favorable publications of research results and editorials.89 Prior to the passing of the Sunshine Act, some people speculated and hoped that publishing the payment and other transfers of value data would cause a decrease in payments or other transfers of value from industry. That objective of the law’s enactment has not come to fruition. Each year, with the explainable exception of the calendar year 2020 due to COVID-19, the total amount of general payments to physicians has increased. It is largely assumed that the decrease in 2020 was associated with less travel and fewer meals and events due to the COVID-19 pandemic. In evaluating payments to oncologists and internists from 2014 through 2017, Rahman et al add to this growing body of literature with a novel examination of industry payments associated with PD-1 and PD-L1 immunotherapy drugs. The recent approval of these products allows for the unique opportunity to evaluate the initial payment pattern for a new and expensive class of drugs. This evaluation by Rahman et al provides several novel and useful insights. They identify a 165% increase in payments to physicians from companies marketing PD-1 or PD-L1 drugs during the study period, compared with a 31% increase from benchmark companies not marketing those drugs. Interestingly, the authors hypothesized that there may be higher payments associated with the annual meeting of the specialty, but that was not substantiated in the data. Lower payments were identified in the summer and the first and last weeks of the year, likely correlating with common vacation times. The authors also found CORY L. ANAND, JD