Industry Payments and Their Role in MS Drug Selection Among High-Volume Prescribers
A recent observational study explored the prevalence of industry payments to neurologists who prescribe multiple sclerosis (MS) disease-modifying therapies (DMTs), uncovering significant associations between such payments and prescribing behavior. By linking the Centers for Medicare & Medicaid Services (CMS) Open Payments data with Medicare Part D prescription claims from 2015 to 2019, researchers analyzed the payment patterns and their potential influence on prescribing practices among 7401 neurologists. The findings highlight a concerning relationship between pharmaceutical marketing efforts and clinical decisions in a market where drug costs are high and therapeutic choices are nuanced.
Nearly 80% of neurologists prescribing MS drugs received industry payments during the study period, amounting to over $163.6 million, with the top 10% of recipients accounting for more than 95% of the total payment value. Payments were primarily associated with non-consulting services, such as speaking engagements, followed by travel and lodging, and food and beverages. Importantly, physicians receiving payments tended to be those with the highest prescription volumes, suggesting that companies selectively target high-volume prescribers. Sanofi and Biogen emerged as dominant players, with the latter achieving the greatest reach among neurologists despite Sanofi making the highest total payments.
The study established a robust association between receipt of industry payments and increased likelihood of prescribing the paying company’s drugs. This association exhibited a dose–response pattern: the more significant, frequent, and recent the payments, the stronger the tendency for a neurologist to prescribe that company's products. For example, receiving even a modest $50 payment was associated with an increased prescribing rate, and this effect grew with higher payments, up to $5000. Similarly, physicians who received payments over multiple years or most recently were more likely to favor the corresponding company’s drugs. Among payment types, non-consulting services such as speaker fees showed the strongest correlation with prescribing behavior.
Importantly, the association between payments and prescribing was more pronounced for moderate-efficacy drugs than for high-efficacy alternatives. This raises critical concerns about whether financial incentives are nudging physicians toward drugs that may not always be the most clinically appropriate, particularly given the high costs associated with brand-name MS therapies. Notably, physicians who received payments from a company’s competitor—but not the company itself—were less likely to prescribe that company’s drugs, further underscoring the competitive nature of pharmaceutical marketing in this therapeutic domain.
While the Open Payments database has provided unprecedented transparency into financial relationships between physicians and industry, the findings from this study suggest that disclosure alone may not be sufficient to mitigate the influence of industry payments on clinical practice. In the context of complex treatment decisions for MS—a disease requiring individualized and often long-term therapeutic strategies—the potential for industry payments to skew physician judgment is especially problematic. As MS drug costs continue to rise, these findings fuel ongoing debate about the ethics of physician-industry relationships and point to a need for stronger policies that curb the promotional practices influencing prescribing patterns in high-cost, high-stakes therapeutic areas.
Reference
Sayed A, Gupta R, Ramachandran R, Rivero-de-Aguilar A, Ross JS. Industry payments to US neurologists related to multiple sclerosis drugs and prescribing (2015-2019): a retro-spective cohort study. BMJ Open. 2025;15(8):e095952. Published 2025 Aug 26. doi:10.1136/bmjopen-2024-095952
