Industry Payments and Prescribing of Brand-Name Multiple Sclerosis Medications in Medicare

Industry payments to clinicians influence prescribing, limiting use of lower-cost generics, and leading to nonadherence. This study of prescribing for multiple sclerosis examined whether payments from brand-name drug manufacturers were associated with prescribing of brand-name glatiramer and dimethyl fumarate after generics became available.

This cross-sectional study used 2021-2022 Open Payments data and 2022-2023 Medicare Part D prescription data. Payments from Teva (glatiramer) and Biogen (dimethyl fumarate) were categorized as none, <$1,000, or ≥$1,000. The outcome was the proportion of brand-name prescriptions per clinician, categorized as low (<20%), medium (20%-79%), or high (≥80%). Associations were assessed using multinomial logistic regression, adjusting for prescriber type, prescription volume, and geographic region.

Among 2,675 glatiramer and 2,138 dimethyl fumarate prescribers, 1,026 (38.4%) and 1,238 (57.9%) received payments, respectively. Receiving ≥$1,000 in payments was associated with a greater odds of high brand-name prescribing for glatiramer (adjusted odds ratio [aOR] 4.21, 95% CI 1.81-9.81, p < 0.001) and dimethyl fumarate (aOR 2.53, 95% CI 1.57-4.07, p < 0.001). Payments <$1,000 were also associated with higher brand-name prescribing.

Payments to clinicians were associated with lower uptake of generic versions of 2 MS drugs, resulting in higher spending by patients and the US health care system.