Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing

Abstract

Objective: To evaluate the impact of the Affordable Care Act's Physician Payments Sunshine Act (PPSA), which mandates disclosure of industry payments to physicians, on physician prescribing of branded statins.Data Sources: Administrative claims data from 2011 to 2015 from three large national commercial insurers were provided by the Health Care Cost Institute.Study Design: We adopted a difference-in-differences and event study design, leveraging the control group of physicians in two states, MA and VT, which implemented state laws on disclosure of industry payments prior to the national PPSA. To further address potential confounding caused by differences in prescribing patterns across states, our analytical sample includes physicians practicing in border counties between the treatment (NH, NY, and RI) and control (MA and VT) states.Data Collection: We restricted our sample to physicians who had at least 50 new-fill prescription claims for statins during the five-year study period, with at least one new-fill prescription claim each year.Principal Findings: We found that the PPSA led to a 7% (p < 0.001) reduction in monthly new prescriptions of brand-name statin over the study period, with little change in generic prescribing. The reduction in branded prescriptions was concentrated among physicians with the highest tercile of drug spending pre-PPSA, with a decrease of 15% (p < 0.001) in new branded statin prescriptions. The decline was most prominent after mandated reporting of industry payments began before the payment data was published. Conclusions:The PPSA may have achieved its intended effect of reducing branded prescriptions at least in the short run, particularly among physicians most likely to have engaged in excessive or low-value prescribing of branded drugs.