Industry Payments Linked to Prescribing Patterns in MS Care

Nearly 80% of US neurologists prescribing multiple sclerosis (MS) disease-modifying therapies (DMTs) between 2015 and 2019 received payments from pharmaceutical companies, and those payments were associated with prescribing patterns, according to a retrospective cohort study published in BMJ Open.1

A study reveals that nearly 80% of US neurologists prescribing MS therapies received industry payments, influencing their prescribing patterns significantly. | Image credit: Yuliia - stock.adobe.com

“Promotional efforts to influence prescribing are especially concerning given the drugs’ substantial costs, particularly if more expensive brand-name drugs are being prescribed instead of appropriate, effective, generically available alternatives,” the authors warned.2

The researchers analyzed data from 7401 neurologists who prescribed MS DMTs to Medicare Part D beneficiaries.1 Industry payment records were drawn from the CMS Open Payments database and linked to prescribing data using physician identifiers. The analysis focused on general payments such as food, travel, consulting fees, speaking honoraria, and educational activities, while excluding research payments and investment interests. The primary outcome was the proportion of prescriptions issued by a neurologist that came from a company providing payments in a given year, assessed through generalized linear mixed models.

From 2015 to 2019, 5809 neurologists (78.5%) received a total of 626,290 payments amounting to $163.6 million. Payments were highly concentrated: the top 10% of recipients accounted for 95.2% of the value, or $155.7 million. The median (IQR) payment per physician was $779 ($188-$2587). Sanofi provided the highest total value of payments ($71.3 million), while Biogen paid the greatest proportion of neurologists (66.2%). Nonconsulting fees, such as speaking engagements, comprised the largest share of spending ($108.4 million, 66.3% of the total), although food and beverage payments were the most common (512,052 transactions to 76% of neurologists).

During the same period, neurologists issued approximately 3.1 million DMT prescriptions, with a median of 266 per physician. Glatiramer acetate (Copaxone; Teva Pharmaceuticals; 24.6%) and dimethyl fumarate (Tecfidera; Biogen; 16.6%) were the most prescribed drugs, and Biogen held the greatest market share at 32.5%. Physicians receiving payments prescribed more DMTs overall; for example, those with no payments wrote a median of 127 prescriptions annually compared with 728 among those receiving consulting fees and 912 among those receiving nonconsulting fees. Larger payment amounts were consistently associated with greater prescribing volume.

Receipt of payments was linked to preferential prescribing. Physicians who received any payment from a company were more likely to prescribe that company’s drugs compared with those who did not (OR, 1.13; 95% CI, 1.11-1.15), with the strongest association for nonconsulting services (OR, 1.53; 95% CI, 1.44-1.62). Even small amounts had measurable effects: a $50 payment was associated with increased likelihood of prescribing (OR, 1.10; 95% CI, 1.08-1.12). The effect rose with payment size, reaching an OR of 1.50 (95% CI, 1.44-1.57) for payments of $5000.

The timing and duration of payments also influenced prescribing. Physicians with payments spanning 5 consecutive years were substantially more likely to prescribe a company’s drugs in 2019 (OR, 1.78; 95% CI, 1.75-1.80). More recent payments showed stronger associations than older ones, although even payments made 4 years earlier were linked to prescribing differences. Subgroup analysis indicated that associations were more pronounced for moderate-efficacy therapies (OR, 1.22; 95% CI, 1.19-1.24) than for high-efficacy agents (OR, 1.07; 95% CI, 1.01-1.13).

The authors noted that their study was limited to Medicare Part D prescriptions and excluded physician-administered drugs billed under Part B. They were unable to assess the appropriateness of prescribing or capture the full scope of physician–industry relationships, and the observational design left the possibility of residual confounding.

“The Physician Payments Sunshine Act, which led to the creation of the Open Payments Database, was an important step forward in making transparent the financial conflicts of interest among physicians receiving industry payments. However, it remains unclear whether increased transparency has mitigated these conflicts of interest and their impact on prescribing behaviour or simply given the public greater insight into the large scale of industry payments made to prescribers,” they noted.2

Overall, the study showed that payments to neurologists prescribing MS drugs were widespread, concentrated among a small group of high-volume prescribers, and consistently associated with preferential prescribing, particularly when payments were larger, longer in duration, and more recent.

Reference

1. Sayed A, Gupta R, Ramachandran R, et al. Industry payments to US neurologists related to multiple sclerosis drugs and prescribing (2015–2019): a retrospective cohort study. BMJ Open. 2025;15:e095952. doi:10.1136/bmjopen-2024-095952

2. Most US neurologists prescribing MS drugs have received pharma industry cash. News release. BMJ Group. August 26, 2025. Accessed August 28, 2025. https://www.eurekalert.org/news-releases/1095648