Restrictions On Pharmaceutical Detailing Reduced Off-Label Prescribing Of Antidepressants And Antipsychotics In Children

Abstract

The treatment of pediatric depression is controversial because it includes substantial prescribing of drugs for uses that have not been approved by the Food and Drug Administration ("off label") and are not evidence based. Some academic medical centers (AMCs) restrict "detailing" by pharmaceutical sales representatives, or the promoting of drugs directly to physicians via sales calls, to reduce the effect of such marketing on physician prescribing. With data from thirty-one geographically diverse AMCs and their affiliated hospitals, we used a difference-in-differences model to estimate the effect of anti-detailing policies on off-label prescribing of antidepressants and antipsychotics by pediatricians and by child and adolescent psychiatrists in the period January 2006-June 2009. We found that after the introduction of such policies, prescriptions for off-label use of promoted drugs fell by 11 percent, consistent with the ongoing presence of off-label marketing to physicians. Prescriptions for on-label use of promoted drugs fell by 34 percent after the adoption of the policies. Conversely, prescriptions for on-label use of nonpromoted drugs rose by 14 percent, and those for offlabel use of nonpromoted drugs rose by 35 percent. These results suggest that pharmaceutical sales representatives promoted drugs not approved for pediatric use and that policies that restrict detailing by those representatives reduced such off-label prescribing.

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

“…Mounting evidence suggests that medical school conflict of interest policies have a significant impact on prescribing (King et al, 2013; Epstein et al, 2013; Larkin et al, 2014). This work has also found that more restrictive policies have a stronger effect on prescribing.…”

“…Recent empirical research has found that medical school policies limiting or prohibiting detailing lead to lower rates of new drug uptake (King et al, 2013), higher rates of generic prescribing (Epstein et al, 2013), and reduced off-label prescribing (Larkin et al, 2014). While this work has significantly advanced our understanding about the impact of medical schools’ conflict of interest policies, three gaps remain in the existing literature.…”

Patterns of Antipsychotic Prescribing by Physicians to Young Children

“…A number of strategies, including prior authorization and step therapy requirements, 39–44 tiered formularies, 45,46 monitoring and feedback (e.g., computerized alerts, reminders, audit and feedback), 47 academic detailing, 48,49 and policies restricting detailing efforts by pharmaceutical manufacturers 50 have proven effective at influencing physician prescribing behavior in general. Payers and health plans could consider applying these approaches to antipsychotic prescribing to young children in an effort to highlight for prescribers the risk-benefit tradeoffs associated with antipsychotic use in children.…”

Conflict of Interest Policies at German medical schools - A long way to go

“…Aside from teaching about industry practices of marketing and promotion, restrictive COI policies at the medical school level have been suggested to increase students' awareness of the consequences of inappropriate marketing practices in the learning environment (22). Some studies indicate that COI policies at medical schools have a significant impact on prescribing practices and inoculate physicians against persuasive aspects of pharmaceutical promotion (23)(24)(25). These studies also show that more restrictive policies were associated with higher compliance of physicians' prescriptions with current guidelines (23)(24)(25).…”

“…Some studies indicate that COI policies at medical schools have a significant impact on prescribing practices and inoculate physicians against persuasive aspects of pharmaceutical promotion (23)(24)(25). These studies also show that more restrictive policies were associated with higher compliance of physicians' prescriptions with current guidelines (23)(24)(25). It has not been clarified which components of a COI policy might have a particularly important impact on physicians' behaviour and attitudes.…”