Marketing of antipsychotic drugs targeted doctors of Medicaid patients, report says

BMJ 2012; 345 doi: (Published 02 October 2012) Cite this as: BMJ 2012;345:e6633
  1. Bob Roehr
  1. 1Washington, DC

Psychiatrists serving the 205 000 low income people covered by the Medicaid program in Washington, DC, disproportionately benefited from gifts and payments from pharmaceutical companies, compared with other local physicians, a study shows.

In addition, children covered by Medicaid, a principal focus of the program, were twice as likely as all Americans to be prescribed antipsychotic drugs. About one child in 10 was prescribed that class of drugs.

Those two associations were gleaned from an analysis of marketing data that pharmaceutical companies reported to the government of the District of Columbia under the AccessRx Act, which was passed in 2004. The George Washington University School of Public Health and Health Services conducted the analysis under a contract from the city, and has published it on the district’s website.1

The law requires companies to report expenditures greater than $25 (£15.5; €19.3) for meals, speaking, and consulting fees, and so on. Spending on research, congressional lobbying, and drug samples are excluded. The law covers all health professionals, not just doctors, and all institutional settings.

Pharmaceutical marketing costs totalled $85.4 million in 2010, when the city’s population was barely over 600 000. Direct payments were made to 172 physicians, totalling $1.9 million, Susan Wood, senior author of the paper, told the BMJ.

About a quarter of that amount, nearly $500 000, went to only 26 psychiatrists. Psychiatrists with patients covered by Medicaid received a greater share of the largesse than those who do not treat Medicaid patients.

“We found a disturbing number of people dependent upon Medicaid who are being prescribed antipsychotic medication,” Wood said. “It shows there is a real effort on the part of manufacturers to disproportionately market antipsychotic drugs to clinicians” who are serving a Medicaid population.

Problematic side effects associated with second generation antipsychotic drugs—those most likely to still be on patent and hence promoted—include sedation, weight gain, diabetes, and metabolic syndrome. A risk-benefit assessment that might be acceptable for serious conditions for which the drug was approved might not be acceptable for off-label use for less serious conditions.

Wood lamented that they did not have access to prescribing data for individual physicians, and so could only draw broad associative conclusions rather than more detailed patterns of associations between receiving gifts and prescribing specific drugs.

The report noted that several US states impose conditions on prescribing antipsychotic drugs to children; California requires preauthorization from the state Medicaid office whereas Texas has created a panel to review those prescriptions for children in foster care.

Wood said they lacked data on prescribing patterns to make similar recommendations for Washington, DC, but their report did urge the city “to start to get that data” with enhanced transparency through more detailed reporting, including use of physician prescriber numbers. Some of those recommendations will probably require changes in the law. She said, “We tried to limit our recommendations to the data and kind of conclusions that we could draw from it.”


Cite this as: BMJ 2012;345:e6633


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