Some of the nation’s largest pharmaceutical companies have slashed
payments to health professionals for promotional speeches amid heightened
public scrutiny of such spending, a new ProPublica
analysis shows.
Eli Lilly and Co.’s payments to speakers dropped by 55
percent, from $47.9 million in 2011 to $21.6 million in 2012.
Pfizer’s speaking payments fell 62 percent over the same
period, from nearly $22 million to $8.3 million.
And Novartis, the largest U.S. drug maker as measured by 2012
sales, spent 40 percent less on speakers that year than it did between October
2010 and September 2011, reducing payments from $24.8 million to $14.8 million.
The sharp declines coincide with increased attention from
regulators, academic institutions and the public to pharmaceutical company
marketing practices. A number of companies have settled federal
whistleblower lawsuits in recent years that accused them of improperly marketing
their drugs.
In addition, the Physician Payment Sunshine Act, a part of
the 2010 health reform law, will soon require all pharmaceutical and medical
device companies to publicly
report payments to physicians. The first disclosures required under the act
are expected in September and will cover the period of August to December 2013.
Within the industry, some companies are reevaluating the
role of physician speakers in their marketing repertoire. GlaxoSmithKline announced
in December that it would stop paying doctors to speak on behalf of its
drugs. Its speaking tab plummeted from $24 million in 2011 to $9.3 million in
2012.
Not all companies have cut speaker payments: Johnson and
Johnson increased such spending by 17 percent from 2011 to 2012; AstraZeneca’s
payments stayed about flat in 2012 after a steep decline the previous year.
ProPublica has been tracking
publicly reported payments by drug companies since 2010 as part of its Dollars
for Docs project. Users can search for their doctors to see if they have received
compensation from the 15 companies that make such information available online.
(We’ve just updated our application
to include payments made through the end of 2012, totaling $2.5 billion. Forest
Labs, which only began reporting in 2012, reported speaking payments of $40
million, more than any other company in Dollars for Docs.)
Some companies in the database said their declines have less
to do with the Sunshine Act and more to do with the loss of patent protection
for key products. Lilly, for example, began facing generic competition to its
blockbuster antipsychotic Zyprexa in late 2011. Its antidepressant Cymbalta
lost its patent at the end of 2013.
“The value of educational programs tends to be higher when
we’re launching a new medicine or we have new clinical data/new indication,” Lilly
spokesman J. Scott MacGregor said in an email, adding that the drop in speaking
payments also reflects the increased use of web conferencing.
Pfizer’s patent on Lipitor, its top-selling cholesterol drug,
expired in 2011.
“Like any other company, our business practices must adapt
to the changing nature of our product portfolio, based in part on products
going off patent and new products being introduced into the market,” company
spokesman Dean Mastrojohn said in an email.
Novartis’ patent for its breast cancer drug Femara expired in 2011, its hypertension drug Diovan in 2012 and its cancer drug Zometa
in 2013. In a statement, Novartis said that speaking payments dropped in 2012,
in part, because of a shift from big blockbuster drugs that many doctors
prescribe toward specialty products prescribed by fewer physicians. Resources were also
shifted “to support potential future product launches.”
The industry’s increased emphasis on expensive specialty
medications for such conditions as multiple sclerosis or Hepatitis C, has been striking,
said Aaron Kesselheim, an assistant professor of
medicine at Harvard Medical School. A piece in the New England Journal of Medicine
last week noted that half
of the 139 drugs approved by the Food and Drug Administration since 2009
were for rare diseases and cancers.
“It’s possible
the number of physicians they need to support sales of these items is less,
leading to lower payments overall,” Kesselheim said.
In some cases, companies maintained or made smaller cuts to
other forms of physician compensation while pulling back dramatically on
speaking payments. Pfizer’s
spending on consultants dropped 9 percent from 2011 to 2012, far less than its
payments to speakers. The company’s spending on research stayed essentially the
same.
Lilly increased spending on physician researchers by more
than 20 percent, while reducing payments to consultants by more than two-thirds.
Many bioethicists and leaders of major academic medical
centers frown upon physicians delivering promotional talks for drug companies,
saying they turn doctors into sales representatives rather than leaders in
research and patient care.
Officials with the Pharmaceutical Research and Manufacturers
of America, the industry trade group, dispute this characterization. They said
they are working with their member companies to prepare for the Sunshine Act
and have created a campaign to promote the value of drug company-doctor
collaborations.
“Companies will make their own independent decisions about
how to engage professionals,” said Kendra Martello, PhRMA’s
deputy vice president of strategic operations.
Scott Liebman, an attorney who
advises pharmaceutical companies on the Sunshine Act, said it’s too early to
know how much the law’s requirements are affecting company practices, in part
because it’s so new. The fact that some companies are cutting back on speaking
while preserving their spending on research and consulting suggests that other
business forces could be at play, he added.
“It’s very hard to pinpoint exactly why that’s happening,” Liebman said. “I think there’s a lot of potential answers
to that. I just don’t know which is the right one.”
