Edmond J. Safra Lab Fellow Genevieve Pham-Kanter presented her paper, “The Effect of Physician Payment Disclosure Laws on Prescribing” (published in JAMA Internal Medicine) at the December 14 Lab seminar. The paper examines the effects of physician payment disclosure laws on physician prescribing habits and patient adherence to therapy, by comparing states which have enacted disclosure laws (Maine and West Virginia) to similar comparison states which have not enacted disclosure laws. Changes in prescribing habits were measured by the fraction of statin prescriptions accounted for by brand name drugs. Patient adherence to therapy was measured by the fraction of prescription refills that were more than 7 days late.
While Pham-Kanter did find a small effect of the laws on the fraction of statin prescriptions that were for brand name drugs, there was no effect on patient adherence to therapy, suggesting that payment disclosure laws are unlikely to have a de-biasing effect on physicians.
In the discussion that followed, some participants pointed out that one might not notice an immediate drop off in branded prescriptions due to old prescriptions that would continue to be filled, and suggested looking at old versus new prescriptions, to see if there might be a larger effect size.
Some critiqued the paper for its assumptions about influence, which they felt was taken for granted. However, others pointed out that pharmaceutical companies would not be likely to give money to doctors unless they were getting something out of it. Since they do give money, it’s safe to assume that they do have an influence.
Considering the issue of transparency, and disclosure of payments to physicians, a few participants noted that some physicians may become so sensitive that they don’t accept anything at all, even payments that aren’t questionable. They wondered whether there might be a way to separate the questionable from the non-questionable payments when such disclosures are made.
The seminar concluded with participants wondering about the deterrence effects of transparency. Pham-Kanter noted that based on her results, the issue is not simply disclosure, but rather the details of what is disclosed, and at what level it is disclosed. As for current disclosure laws, their deterrence effect seems to be quite small.