Manufacturer Engagement with Clinicians and Buprenorphine Prescribing: Evidence from Linked Open Payments and National Pharmacy Claims

• In Event: Increasing Access to Medications for Opioid Use Disorder

Abstract

Despite reforms to expand buprenorphine access for opioid use disorder (OUD), fewer than one in five individuals with OUD receive medications for OUD (MOUD) annually. Pharmaceutical manufacturer engagement may influence buprenorphine prescribing but has not been studied in the MOUD context. We linked Open Payments data (2014–2023) capturing manufacturer-to-clinician visits with IQVIA Longitudinal Prescription data (2013–2024) covering more than 90 percent of US retail pharmacy dispensing. We also merged in NPPES data to infer when a clinician is actively practicing. Among 223,065 buprenorphine prescribers who are recorded in the IQVIA data and have a known specialty, approximately 7 percent received at least one visit from a manufacturer during our sample period. We first analyze the general targetting strategy of manufactuers. We find that manufacturers tend to target already-prescribing providers, specifically those prescribing higher-than-average volumes of Buprenorphine. There has also been a shift in targetting toward advanced practice physicians (APPs) in recent years. With regard to the effect of these manufactuer vists, staggered difference-in-differences models found that visits were associated with a statistically significant increase in prescribing of over 450 daily doses of Buprenorphine prescribed per visited prescriber per quarter, corresponding to an approximately 25% increase in prescribing volume. These general results hold for advanced practice providers (APPs), primary care physicians (Generalists), and other types of physicians (Specialists). Dose-response analysis suggest that more visits results in a larger effect in prescribing changes, with prescribers only receiving one visit having no significant change in their prescribing volume. Further heterogeneity analysis finds that the response from a visit is similar for physicians practicing in high opioid-related mortality counties compared to low opioid-related mortality counties, although there are differences when looking at APPs, Generalists and Specialists separately. We also conduct stratified analyses to estimate the difference in response among previously high (before their first visit from a manufactuer) versus low volume prescribers, as well as prescribers who were already prescribing Buprenorphine versus those who were not. While there are differences in the estimated effect in these stratfied analyses, the general positive impact of these detailing visits holds in all of them. While are results suggest that manufacturer promotion may expand buprenorphine prescribing, it may still not reach the clinicians and communities where unmet need is greatest since already prescribing, high volume prescribers, and prescribers in high opioid-related mortality counties are targetted much more frequently than other prescribers.

Author

• Costas Lambros, Indiana University
  Presenting Author