Ninety-four percent of physicians have some type of relationship with the pharmaceutical industry, and most of these relationships involve receiving food in the workplace (83 percent) or drug samples (78 percent), according to a study in the New England Journal of Medicine. More than one third of the respondents (35 percent) receive reimbursement for costs associated with professional meetings or continuing medical education, and more than one quarter (28 percent) receive payments for consulting, lecturing, or enrolling patients in clinical trials.

Of the six specialists surveyed (anesthesiologists, cardiologists, family practitioners, general surgeons, internists, and pediatricians), cardiologists are more than twice as likely as family practitioners to receive payments. But family physicians meet more frequently with industry representatives than do other specialists.

Physicians in solo, duo, or larger practices are significantly more likely to have relationships with industry than are physicians in hospitals or clinics that may have policies that restrict physician–industry relationships. In addition, small practices may have more freedom in their prescribing choices than physicians in hospitals and clinics, which usually follow a formulary.

Finally, hospitals and clinics may offer medical information through grand rounds or CME events, making physicians feel less dependent on industry representatives as a source of medical information.

No such thing as a free lunch?

In a national survey, 3,167 physicians in six specialties were asked "Which of the following have you received in the last year from drug, device, or other medically-related companies?"

Chart by Julie Ridge

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.