CRIMINAL CAPITALI$M
Most US neurologists prescribing MS drugs have received pharma industry cash
Higher volume prescribers more likely to receive payments; and recipients more likely to prescribe that company’s drugs, especially if payments were larger, sustained, and recent
BMJ Group
Nearly 80% of US neurologists prescribing drugs for multiple sclerosis (MS) received at least one pharma industry payment, with higher volume prescribers more likely to be beneficiaries, finds a 5 year analysis of Medicare database payments, published in the open access journal BMJ Open.
And those in receipt of these payments were more likely to prescribe that company’s drugs, especially if the sums involved were larger, sustained, and recent, the findings indicate.
Because of the lifelong nature of MS, effective therapies are usually continued indefinitely unless a patient’s clinical response changes, explain the researchers. And MS drug prescriptions are Medicare’s largest neurological drug expense despite making up a relatively small portion of total claims, they add.
While previously published research indicates that industry payments are associated with increased prescribing of marketed products, none of these studies focused on a market as competitive as the MS drugs market, say the researchers.
They therefore set out to characterise industry payments to neurologists prescribing MS drugs and find out if the receipt of such payments might be associated with the likelihood of the preferential prescribing of that company’s drugs.
They used publicly available data on payments made by pharma companies to doctors from the Centers for Medicare & Medicaid (CMS) Open Payments platform from 2015 to 2019.
Payments are classified as: research payments; ownership and investment interests; and general payments. The researchers focused on general payments to neurologists, linking these to Medicare Part D data, which covers prescription drugs, using National Provider Identification numbers and drug names.
Their analysis included 7401 neurologists who had prescribed disease modifying therapies (DMTs) for at least 1 year, issuing a minimum of 11 prescriptions, and 20 DMTs manufactured by 10 companies.
In all, 5809 (78.5%) neurologists received 626,290 distinct industry payments from at least one drug company, totalling US$163.6 million between 2015 and 2019; 4999 (67.5%) neurologists received payments from two or more companies.
The average individual amount received was US$779, but 10% of recipients amassed US$155.7 million between them—95% of the total sums received–which suggests that drug companies may selectively target high-volume prescribers, say the researchers.
Higher prescription volumes were associated with a greater likelihood of receiving any payment type, particularly for consulting services, non-consulting services, such as speaking at an event, and travel/accommodation; the highest number of discrete payments was made for food and drink.
The amount received was positively associated with prescription volume. Compared with those who received no payments from a company, those who did, were 13% more likely to prescribe that company’s drugs.
The strongest association between industry payment and prescribing tendencies was observed for non-consulting services. These neurologists were 53% more likely to prescribe that company’s drugs.
Larger payments were also associated with a greater likelihood of preferential prescribing, rising in tandem with the size of the payment received: US$50 was associated with a 10% greater likelihood of prescribing that company’s drugs; US$500 with a 26% greater likelihood; US$1000 with a 29% greater likelihood; and US$5000 with a 50% greater likelihood.
Longer duration of payments was another seemingly influential factor, ranging from a 12% greater likelihood of prescribing that company’s drugs for one year of payments to 78% greater likelihood for 5 consecutive years.
The recency of payments also seemed to be influential. A payment made 4 years earlier was associated with a 3% greater likelihood of prescribing that company’s drugs, but a 34% greater likelihood when made in the same year.
This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that their study was limited to the prescribing of Part D drugs, and couldn’t establish the appropriateness of prescribing, nor for which patients more expensive brand-name drugs were most suitable.
A doctor’s decision to prescribe is informed by many different factors, including national guidelines and/or institutional protocols, insurance cover, and patient preferences. These drivers are difficult to assess using publicly available data, but should be considered when interpreting the findings, emphasise the researchers.
Nevertheless their “findings raise concerns about excess pharmaceutical promotion efforts and their implications for physician prescribing for patients,” they suggest.
“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,” they point out.
“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 conclude.
Journal
BMJ Open
Method of Research
Observational study
Subject of Research
People
Article Title
Industry payments to US neurologists related to multiple sclerosis drugs and prescribing (2015–2019): a retrospective cohort study
Article Publication Date
26-Aug-2025
COI Statement
All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare no support from any organisation for the submitted work; JSR was an expert witness at the request of Relator's attorneys, the Greene Law Firm, in a qui tam suit alleging violations of the False Claims Act and Anti-Kickback Statute against Biogen that was settled in September 2022.
How Big Pharma Bought Government to Protect its Racket
The US government is pay-to-play – and drug lobbyists are buying a lot of playing time.
Pharmaceutical companies claim that the government shouldn’t negotiate lower drug prices because losing those excess profits will hurt innovation, but they can pour record amounts of money into lobbying the government. The premier lobbying group for Big Pharma – the Pharmaceutical Research and Manufacturers of America (PhRMA) – spent over $20.6 million on lobbying the federal government in the first half of 2025, including more than $7.6 million in the second quarter.
Pharmaceutical and health products companies overall spent $105.4 million in the second quarter of 2025 and $226.8 million for the first half the year. This lobbying boom is an extension of growing spending over the last few years, as the industry spent around $22 million more than it had in the first half of 2024.
Lobbying literally means the act of influencing government actions, and PhRMA’s spending successfully reaped rewards in the recently signed reconciliation packagethat President Trump coined the “One Big Beautiful Bill” (OBBB).
The United States spends far more than other countries for the same prescription drugs. Compared to the 38 countries in the Organisation for Economic Co-operation and Development (OECD) – which are mostly other democratic, developed nations – US prices were roughly three times as high for the same products. Estimates haveshown two-thirds to three-fourths of global pharmaceutical profits come from the US alone. The pharmaceutical industry achieved two massive wins in the OBBB to help ensure that this price gouging of Americans continues.
What PhRMA Won in the OBBB
Unlike other countries, the US government doesn’t use its significant purchasing power to negotiate and lower prices. However, the 2022 Inflation Reduction Act (IRA) introduced very limited drug negotiation in the Medicare program for the 50 drugs with the highest amount of spending in Medicare Parts B and D each. More specifically, the IRA allows Medicare to negotiate prices for a whopping 10 drugs starting in 2026, adding another 15 in 2027, another 15 in 2028, and 20 in 2029 and beyond.
The OBBB increased the number of drugs exempted from the limited price negotiation program, which the Congressional Budget Office estimates will save the industry $5 billion over ten years. Before the OBBB, drugs that the Food and Drug Administration (FDA) approved to treat patient populations of under 200,000 for a single rare disease – known as orphan drugs – were exempt from price negotiation.
The OBBB tweaked the law so that drugs approved to treat multiple rare diseases are also exempt. This change is significant, as pharmaceutical companies often chase orphan drug designations for their products because they provide significant financial incentives like tax credits, fee exemptions, grants, and market exclusivities. Orphan drugs are also significantly more expensive than nonorphan drugs. One analysis of 242 FDA-approved orphan and nonorphan drugs from 2017-2021 found that the median cost of orphan drugs was roughly $219,000 compared to $13,000 for nonorphan drugs.
The other significant win for the pharmaceutical industry was the exclusion of a supposed Trump policy to lower drug prices. In May 2025, President Trump issuedan executive order claiming to create a most-favored-nation policy to lower drug prices. Essentially, such a policy would set the prices of drugs in the US to the lowest level paid by comparable countries. However, President Trump issued a similar executive order in his first administration, which the courts struck down for violatinglegal procedures.
To put President Trump’s executive order into law, Representatives Ro Khanna (D-CA), Anna Paulina Luna (R-FL), Marcy Kaptur (D-OH), and Andy Biggs (R-AZ) introduced the Global Fairness in Drug Pricing Act in May to codify key provisions of the executive order. Yet, the OBBB did not include this bipartisan policy. The pharmaceutical industry won out again.
The industry’s lobbying successes do not end there. Among its other wins, the OBBB nor any other piece of legislation has included Department of Health & Human Services (HHS) Secretary Robert Kennedy’s desire to rein in direct-to-consumer advertising. Currently, the United States and New Zealand are the only two countries that allow pharmaceutical companies to spend money directly advertising their drugs to consumers. Additionally, companies are financially incentivized to spend big on such advertising as these expenditures are exempt from federal taxes. Secretary Kennedy has openly endorsed ending this tax exemption and Senators Josh Hawley (R-MO) and Jeanne Shaheen (D-NH) have introduced the No Handouts for Drug Advertisements Act to do so.
Senators Bernie Sanders (I-VT) and Angus King (I-ME) also introduced legislation to ban such direct-to-consumer advertising outright, a policy that Secretary Kennedy has repeatedly advocated for. Unsurprisingly, Congress has not passed such a ban.
Why do drug companies spend millions on lobbying the federal government when they also price-gouge Americans so that they reap every last penny while willingly and knowingly denying life-saving treatments to patients? The same question applies to the tens of millions of dollars the industry spends through campaign contributions to members of Congress.
The answer is clear: Influence. Companies know that by spending more money to get favorable candidates elected, and by bombarding elected officials, their staff, and regulators with their priorities, they can reap massive profits.
Spending millions on lobbying and campaign contributions can influence policy that creates billions in returns – either from changes in public policy or by maintaining the status quo. Demonstrating the magnitude of this dynamic, one study found that every $1 corporations spent on lobbying for a tax holiday provision in the American Jobs Creation Act of 2004 yielded $220 – a 22,000 percent return on investment. For many pharmaceutical companies and other corporate interests, buying political power is arguably the most lucrative investment they can make.
This first appeared on CEPR.
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