Drug Dollars Seek to Convince Doctors That 2nd Choice Is OK

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Pitching Medicine to America's Doctors
Diabetes drugs and blood thinners dominated drug companies' payments and perks that went to U.S. doctors and hospitals last year.

U.S. doctors and hospitals received more than $20 million last year in payments related to AstraZeneca Plc’s diabetes drug Bydureon, more than for any other medication, newly released company disclosures show.

Drugmakers spent more than $10 million in 2014 on each of 10 different drugs through cash payments and items of value given to U.S. doctors and hospitals, according to a Bloomberg compilation of the data released Tuesday by a U.S health agency. The payments include consulting and speaking fees, honoraria, meals and travel expenses associated with marketing or educating doctors about a drug.

Three of the drugs with the most doctor payments are diabetes medications, which vie in a crowded market of competing products. Three blood thinners also made the top 10, including Xarelto from Johnson & Johnson, Eliquis from Pfizer Inc. and Bristol-Myers Squibb Co., and AstraZeneca’s anti-clotting agent Brilinta.

Jerry Avorn, a professor of medicine at Harvard Medical School, said some of the diabetes drugs linked to bigger payments aren’t the recommended first choices for doctors.

“It’s striking that the top two drugs are expensive new products for diabetes that are by no means first-line choices,” he said in an e-mail. “No one is spending this kind of money to educate doctors about metformin, the inexpensive generic drug that’s the most important foundational treatment we have for this disease.”

Multiple Drugs

The Bloomberg analysis excludes payments for research and for royalties and licensing fees paid to hospitals or doctors for inventing a drug or technology used in making it.

In some cases, drug companies listed multiple drugs associated with a payment to a doctor. Bloomberg tallied the full payments toward each drug’s total, since the manufacturers didn’t say what portion of the payment was for each drug. This may result in higher totals per drug.

AstraZeneca made $22.5 million in payments related to Bydureon, according to the data. The drugmaker said the correct figure is $21.9 million, which would still make it the top drug.

“Patients ultimately benefit when physicians are well informed and knowledgeable about our medicines,” the company said in a statement.

Johnson & Johnson’s diabetes drug Invokana, introduced in 2013, was second on the list with $19.8 million of payments to doctors and hospitals associated with it.

“Generally speaking, drugs that are in their launch phase will tend to be higher because we are doing more work to ensure that physicians understand how to properly use the medicines,” said Ernie Knewitz, a spokesman for Johnson & Johnson. The company didn’t address the Bloomberg calculation.

Competitive Categories

Analysts said one reason blood thinners and diabetes drugs are near the top of the doctor spending list is that both of these are complicated and competitive categories used by generalists and specialists. This results in lots of spending by companies to get their message out.

In “a crowded class where the benefits of one drug over another are unclear, it is going to be in the pharmaceutical company’s interest to try to highlight a drug’s benefits, which of course requires promotion,” said Les Funtleyder, health-care portfolio manager at E Squared Asset Management.

J&J’s Xarelto had $18.7 million of payments associated with it last year, according to the Bloomberg analysis. It’s approved for a number of uses across doctor categories “so it is continually in launch mode,” Knewitz said.

Different Doctors

Pfizer and Bristol-Myers combined spent $18.6 million in payments linked to Eliquis, which competes against Xarelto in treating atrial fibrillation, a heart-rhythm condition.

Because Eliquis is used by a number of different types of doctors, “it is critical to have different speaker programs that adequately provide in-depth education to health care professionals,” Bristol-Myers said in a statement on behalf of both companies. Pfizer said the numbers “look about right.”

Overall, U.S. doctors and teaching hospitals got $6.49 billion from drug and medical-device makers in 2014, according to the data released by the Centers for Medicare and Medicaid Services. The payments are listed in two broad categories: money to fund research and payments to entertain doctors or compensate them for consulting or other non-research purposes.

The disclosures, the first release of full-year data, cover payments to about 607,000 doctors and 1,121 teaching hospitals. Overall, companies made $3.23 billion in payments for research and $2.56 billion for other purposes, according to a summary posted on the website. The data also include ownership interests of $703 million.

Victoza, a diabetes drug from Novo Nordisk A/S that competes with Bydureon, had $15.1 million in company spending on doctors and hospitals associated with it last year, according to Bloomberg’s tally. In an e-mail, Novo Nordisk said it wouldn’t be accurate to call all of that “payments.”

The figures also represent the value of consulting fees, travel and lodging for consultants and speakers, and meals and snacks, according to Ken Inchausti, a spokesman. The spending furthers doctors’ education about products and is used to seek expertise on the disease, Inchausti said.

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