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May 29, 2020Research

Industry payments to physicians and prescribing branded memantine and donepezil combination

Zachary A. Marcum, Ching-Yuan Chang, Douglas Barthold, Holly M. Holmes, Wei-Hsuan Lo-Ciganic, MSPharm
First published May 29, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000000870
Zachary A. Marcum
1Department of Pharmacy, University of Washington, Seattle, WA
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Ching-Yuan Chang
2Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
3Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL
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Douglas Barthold
1Department of Pharmacy, University of Washington, Seattle, WA
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Holly M. Holmes
4Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
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Wei-Hsuan Lo-Ciganic, MSPharm
2Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
3Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL
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Industry payments to physicians and prescribing branded memantine and donepezil combination
Zachary A. Marcum, Ching-Yuan Chang, Douglas Barthold, Holly M. Holmes, Wei-Hsuan Lo-Ciganic, MSPharm
Neurol Clin Pract May 2020, 10.1212/CPJ.0000000000000870; DOI: 10.1212/CPJ.0000000000000870

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ABSTRACT

Objective: Once-daily extended-released memantine with donepezil (hereafter memantine/donepezil) may improve medication adherence but has a 60-fold higher cost compared to combined generic components. Little is known about factors associated with prescribing memantine/donepezil. We examined the association between pharmaceutical industry payments to physicians and prescribing memantine/donepezil in Medicare.

Methods: A cross-sectional study. Using 2015-2016 Centers for Medicare and Medicaid Services Open Payments and Part D prescription databases, we identified unique physicians who prescribed ≥11 memantine/donepezil prescriptions from 2015 to 2016. Outcome variable was the number of memantine/donepezil prescriptions written per physician per year. Key independent variable was physician receipt of industry payments defined in two models: (1) number of payments, and (2) amount of payment ($100 units) for memantine/donepezil received per physician per year. Multivariable Poisson regression was used, adjusting for potential confounders.

Results: Among 4,895 unique eligible physicians in 2015-2016, the median number of memantine/donepezil prescriptions per physician per year was 19.5 (25th percentile=13, 75th percentile=32). Physicians received between 0 and 75 payments per year (median=1, 25th percentile=0, 75th percentile=2.5) for memantine/donepezil, totaling an average of $92 per year (median=$10.5, 25th percentile=$0, 75th percentile=$33.20). Every 1 additional payment received was associated with a 2% increase in new memantine/donepezil prescriptions prescribed per physician per year (rate ratio [RR]=1.02, 95% confidence interval [CI]=1.02-1.02). Every $100 increase in payment for memantine/donepezil was associated with a 0.3% increase in new memantine/donepezil prescriptions prescribed per physician per pear (RR=1.003, 95% CI=1.002-1.004).

Conclusions: Receipt of industry payments for memantine/donepezil was independently associated with increased likelihood of physician prescribing memantine/donepezil in Medicare.

  • Accepted March 5, 2020.
  • © 2020 American Academy of Neurology

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