Highlights
Pharmaceutical industry payments to neurologists significantly influence prescribing decisions for multiple sclerosis (MS) medications. Clinicians receiving $1,000 or more from brand-name drug manufacturers demonstrated substantially higher rates of prescribing expensive brand-name versions over available generics. This prescribing pattern carries profound implications for healthcare costs and patient access to affordable treatments.
Background: The Multiple Sclerosis Treatment Landscape
Multiple sclerosis represents one of the most common neurological disabilities affecting young adults worldwide, with approximately 2.8 million individuals living with MS in the United States alone. The disease imposes substantial economic burden, with annual healthcare costs exceeding $28 billion nationally. Disease-modifying therapies form the cornerstone of MS management, with glatiramer acetate and dimethyl fumarate serving as widely prescribed first-line options.
The introduction of generic alternatives for these medications promised significant cost savings for both patients and the healthcare system. Generic versions of glatiramer acetate became available following patent expiration, as did generics for dimethyl fumarate. These generics typically cost 70-85% less than their brand-name counterparts, representing potential savings of hundreds of millions of dollars annually if widely adopted.
However, the translation of generic availability into clinical practice has been inconsistent. Previous research across multiple therapeutic areas has demonstrated that industry payments to healthcare providers influence prescribing behavior, raising concerns about the adoption of cost-effective generic alternatives. The Open Payments Program, established under the Sunshine Act, now provides transparency into financial relationships between physicians and pharmaceutical manufacturers, enabling researchers to examine these associations systematically.
Study Design and Methods
This cross-sectional study utilized data from two primary sources: the 2021-2022 Open Payments data and 2022-2023 Medicare Part D prescription data. The Open Payments database captures all transfers of value from pharmaceutical and medical device manufacturers to physicians, including consulting fees, speaker honoraria, research funding, and meals.
The researchers focused on payments from two specific manufacturers with substantial market presence in MS treatment: Teva Pharmaceuticals (manufacturer of glatiramer acetate, marketed as Copaxone) and Biogen (manufacturer of dimethyl fumarate, marketed as Tecfidera). Payment categories were defined as none, less than $1,000, and $1,000 or more, reflecting thresholds commonly used in policy discussions regarding disclosure requirements.
The study population included all clinicians who prescribed either glatiramer acetate or dimethyl fumarate to Medicare beneficiaries during the study period. Prescribing outcomes were measured as the proportion of brand-name prescriptions per clinician, categorized into three tiers: low brand-name prescribing (less than 20%), medium brand-name prescribing (20-79%), and high brand-name prescribing (80% or greater).
Multinomial logistic regression analyses were conducted to assess associations between payment categories and prescribing patterns, adjusting for potential confounders including prescriber type (neurologist versus non-neurologist), prescription volume, and geographic region. This analytical approach allowed researchers to isolate the independent effect of industry payments on prescribing behavior while controlling for other factors that might influence medication choices.
Key Findings
The analysis included 2,675 prescribers of glatiramer acetate and 2,138 prescribers of dimethyl fumarate, representing a substantial sample of clinicians managing MS patients within the Medicare system.
Prevalence of Industry Payments
A striking proportion of prescribers received industry payments. For glatiramer acetate, 1,026 prescribers (38.4%) received at least one payment from Teva during the study period. For dimethyl fumarate, the proportion was even higher, with 1,238 prescribers (57.9%) receiving payments from Biogen. These figures underscore the extensive financial relationships between MS specialists and pharmaceutical manufacturers.
Association Between Payments and Brand-Name Prescribing
The study revealed powerful associations between industry payments and prescribing of brand-name medications. Clinicians receiving $1,000 or more in payments demonstrated dramatically higher odds of being high brand-name prescribers:
For glatiramer acetate, receipt of $1,000 or more in payments was associated with an adjusted odds ratio of 4.21 (95% CI 1.81-9.81, p < 0.001) for high brand-name prescribing compared to low brand-name prescribing. This means that highly paid prescribers were more than four times as likely to predominantly prescribe the expensive brand-name version when generics were available.
For dimethyl fumarate, the association was similarly pronounced, with an adjusted odds ratio of 2.53 (95% CI 1.57-4.07, p < 0.001) for high brand-name prescribing among those receiving $1,000 or more. Even payments below the $1,000 threshold showed associations with increased brand-name prescribing for both medications, though effect sizes were smaller.
These findings remained statistically significant after comprehensive adjustment for prescriber characteristics, practice volume, and regional factors, strongly suggesting that the observed associations reflect a genuine influence of industry payments on prescribing decisions rather than confounding by provider attributes.
Expert Commentary: Implications and Context
The implications of these findings extend far beyond individual prescribing decisions. Dr. Aaron S. Kesselheim, one of the study authors and a recognized expert in pharmaceutical policy at Brigham and Women’s Hospital, has previously documented similar patterns across multiple therapeutic areas. The consistency of these findings across different drug classes and manufacturers strengthens the argument that industry payments represent an modifiable factor influencing prescribing behavior.
From a health policy perspective, these results illuminate a mechanism driving unnecessary healthcare expenditure. When physicians prescribe brand-name medications despite the availability of therapeutically equivalent and substantially cheaper generics, patients face higher out-of-pocket costs, and the healthcare system bears unnecessary financial burden. Given the chronic nature of MS and the lifelong medication requirements for most patients, the cumulative cost impact of these prescribing patterns is substantial.
The study possesses several methodological strengths, including its large sample size, use of publicly available payment data, and rigorous statistical adjustment. However, several limitations merit consideration. The cross-sectional design precludes definitive conclusions about causality—while the association is strong, it remains possible that manufacturers preferentially target physicians already inclined toward brand-name prescribing. Additionally, the study examined only Medicare Part D prescribers, and patterns might differ in other payer populations. The Open Payments data captures only reportable transfers of value, potentially underestimating the true extent of financial relationships.
The biological plausibility of these associations rests on established principles of behavioral economics. Even seemingly modest payments, meals, or educational materials may activate reciprocity mechanisms and increase awareness of specific brand-name products. The pharmaceutical industry’s substantial investment in physician outreach—totaling billions of dollars annually across all manufacturers—reflects industry recognition of the effectiveness of these strategies in influencing prescribing.
Conclusion
This study provides compelling evidence that financial relationships between pharmaceutical manufacturers and MS specialists significantly influence prescribing patterns, impeding the adoption of cost-saving generic alternatives. The magnitude of effect—with adjusted odds ratios exceeding 4 for high-dose payments for glatiramer acetate and 2.5 for dimethyl fumarate—represents clinically meaningful influence that translates into substantial healthcare expenditure.
These findings reinforce the importance of transparency in industry-physician relationships and suggest that policies aimed at decoupling prescribing decisions from financial incentives may improve healthcare value. Patients and payers deserve confidence that medication choices reflect optimal therapeutic considerations rather than external financial influences. Future research should examine interventions—whether policy-based, educational, or structural—that might effectively realign prescribing incentives with patient-centered, cost-effective care.
The path toward sustainable healthcare spending requires addressing multiple determinants of prescribing behavior, but evidence such as this study provides a clear starting point: minimizing unnecessary industry payments to prescribers represents a straightforward strategy with potential for meaningful impact on healthcare costs and patient access to affordable medications.
Funding and Disclosures
This research was conducted using publicly available data from the Centers for Medicare and Medicaid Services Open Payments Program and Medicare Part D Prescription Drug Event files. The original study was published in Neurology. No specific funding information for the study was disclosed in the provided materials.
References
1. Patel AN, Kesselheim AS, Rome BN. Industry Payments and Prescribing of Brand-Name Multiple Sclerosis Medications in Medicare. Neurology. 2026-04-06;106(8):e214834. PMID: 41941704.
2. Open Payments Program. Centers for Medicare and Medicaid Services. Available at: https://openpaymentsdata.cms.gov.
3. Multiple Sclerosis International Federation. Atlas of MS, 3rd Edition. 2020.
