Effect of Physician Payment Disclosure Laws on Prescribing

To the Editor: With the enactment of the Physician Payments Sunshine Provision of the Affordable Care Act, pharmaceutical manufacturers are now required to disclose certain types of payments—e.g. payments for consulting, honoraria, gifts, and travel—made to physicians.1 This law is based on the premise that transparency in these kinds of transactions is of public importance and that disclosure requirements can act as a deterrent against quid pro quo exchanges; physicians will be reluctant to accept large payments from pharmaceutical firms if payments are publicly known and perceived as financial compensation for prescribing certain therapies.2,3 To predict possible deterrence effects of the federal sunshine law, we studied the experience of two states, Maine and West Virginia, that previously implemented similar disclosure laws. We focused on the effect of the laws on the prescribing of HMG-CoA reductase inhibitors (statins) and selective serotonin reuptake inhibitors (SSRIs), two therapeutic classes in which marketing plays an important role in physicians' choice of treatment because the members within each class are pharmacologically similar to each other and highly substitutable. We hypothesized that, to the degree that physicians were influenced by industry payments to overprescribe branded therapies—and disclosure deterred doctors from accepting these payments—the disclosure laws would lead physicians to decrease prescribing of branded statins and SSRIs. We also looked at whether any switching from branded therapies to generics that we observed was associated with decreases in out-of-pocket costs for patients or decreases in overall prescription expenditures.