# Do doctors actually get a cut for prescribing certain drugs? **URL:** \ **Category:** Factual Questions\ **Created:** [September 14, 2013, 4:28am UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823 "2013-09-14T04:28:37Z")\ **Posts on this page:** 10\ **Page:** 2
**Author:** ![Truman\_Burbank](https://avatars.discourse-cdn.com/v4/letter/t/ecc23a/32.png) [@Truman\_Burbank](https://boards.straightdope.com/u/Truman_Burbank)\ **Post date:** [September 14, 2013, 7:51pm UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/21 "2013-09-14T19:51:32Z")
My wife’s psychotherapy office seems to get fed on a regular basis. My clinic won’t allow it. Also, back to the OP, I’ve been told by several of our psychiatrists that it is fairly common, with so many similar medications competing against each other, that if an MD finds 3 or 4 antidepressants their clients seem to have good response to, the MD will pretty much begin to confine themselves to those meds, at least initially, with the advantage being that they get to know the medication and it’s effects more intimately than if they were regularly prescribing 10 meds in some sort of haphazard rotation. As a non-MD, I think I’ve even seen this go a bit too far, where a psychiatrist seems to get married to just one or two meds and becomes reluctant to prescribe something else. ---
**Author:** ![Chief\_Pedant](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@Chief\_Pedant](https://boards.straightdope.com/u/Chief_Pedant)\ **Post date:** [September 15, 2013, 2:18pm UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/22 "2013-09-15T14:18:30Z")
> [@lazarus86](#): > > I always hear this; “Drug companies bribe doctors to prescribe their drugs. Doctors get a commission on every drug they prescribe so they will prescribe you with unnecessary drugs, so don’t trust them.” > > I don’t doubt pharmaceutical companies are big businesses who try and push their products. > I don’t doubt they send hot women to meet doctors and try and show off their products. > I don’t doubt doctors get wooed with meals and tickets to consider it. > > BUT…how would a drug company know what a Dr. is prescribing? The doctor prescribes something in your name on his/her RX pad, and you get the white copy, they keep the carbon copy. > > Are they supposedly showing the carbon copy to the RX company? That’s the only way I could see this being true. If so, that would be a huge breach of your privacy and I doubt they would risk their practice for this. Also, how does the RX company know which pharmacy you’re going to, if you’re getting the generic brand, etc.? > > My doctor is wary to prescribe meds and when he does he will say the generic one is cheaper and the same thing. > So do they actually get a cut? If so, how does that work? Whoever is talking inside your quotes is a simpleton. The [Stark Laws](http://en.wikipedia.org/wiki/Stark_Law) prohibit physicians and health enterprises from directly benefiting from what’s termed “designated health services” if any kind of “financial relationship” (including any sort of compensation) is involved between the two entitites. While the Stark laws apply to Medicare/Medicaid patients, they have become the defacto ethical standard. Only outright charlatans risking a visit to the Big House would flout them openly. There’s no end to fairly minor machinations around them, including having pharmacy representatives be attractive and personable. But in general the really halcyon kickback days, and for that matter, even Lily lunches for the office staff, are mostly gone. Courting of researches by pharmaceutical companies gets quite close scrutiny as well. The second part of your OP is much more interesting. There is a boatload of money and controversy tied up in patient data. Your description of a filled prescription as a private paper transaction is wildly inaccurate for the vast majority of prescriptions, and particularly so for any prescription handled via a Pharmacy Benefit Manager. There may be a minority of pharmacies handling paper-only scripts, I suppose. But the vast majority of the time, your prescription is entered into an electronic system of some sort, and finds its way into one of the PBMs. Among the advantages of this are easier storage, evaluation against recorded allergies and the like, compatibility checks with other meds “in the system,” and for a couple hundred million of us, consideration for a third-party payer to cough up payment. The scope of how PBMs gather, store and exchange this data is beyond this post, but suffice it to say that the majority of prescriptions exist as an electronic transaction zipping all over the place. Aggregating and analyzing this data has become an enormous industry because its value is equally enormous. Kaiser Permanente wants to know if Lipitor actually does any good, and if it does, they want to know which of their patients who should be taking it are being prescribed Lipitor. They want to know which of their doctors are neglecting to prescribe it. Pfizer wants to know the same thing. So do insurance companies…you get the idea. There are various ways to scrub data of individual patient identification, and various times when that data should not be scrubbed. It’s a whole complex mess. But the short answer is that pharmaceutical companies do know what is being prescribed, and where, and a lot of other detail as well. They don’t actually typically care whether Suzie Smith or John Doe was the actual patient, but the do have a reasonably good idea if Dr Smith or Dr Doe generates many Lipitor prescriptions. ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [September 15, 2013, 3:57pm UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/23 "2013-09-15T15:57:05Z")
> [@Chief\_Pedant](#): > > Whoever is talking inside your quotes is a simpleton. > > The [Stark Laws](http://en.wikipedia.org/wiki/Stark_Law) prohibit physicians and health enterprises from directly benefiting from what’s termed “designated health services” if any kind of “financial relationship” (including any sort of compensation) is involved between the two entitites. While the Stark laws apply to Medicare/Medicaid patients, they have become the defacto ethical standard. Only outright charlatans risking a visit to the Big House would flout them openly. There’s no end to fairly minor machinations around them, including having pharmacy representatives be attractive and personable. But in general the really halcyon kickback days, and for that matter, even Lily lunches for the office staff, are mostly gone… I saw what you did there. ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [September 15, 2013, 7:11pm UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/24 "2013-09-15T19:11:50Z")
> [@Leo\_Bloom](#): > > Just an anecdote from another industry, where nobody gives a shit at this practice: academia. > > I was just made to buy a ludicrously inappropriate, elementary text for an upper-level course. > > Turns out the chairman of the department wrote it. I beg your pardon but I cared a lot. I once had to choose a text for a course. I found five books that were appropriate. I wrote to all five publishers asking about the price. Two didn’t answer, two wrote me with the price, and the last wrote that that information was proprietary! The price Proprietary? WTF? Anyway, I chose the cheaper of the two who gave me the price. My family doctor gives a talk once a year on metabolic disease. A drug company pays the hotel where it is held and pays for a few healthy snacks. Their name is there, but he mentions no drugs and it is hard to believe it effects his prescribing. Much worse is the common practice of having papers written by a flack and paying a doctor to have his name on the paper. ---
**Author:** ![IvoryTowerDenizen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ivorytowerdenizen/32/17937_2.png) [@IvoryTowerDenizen](https://boards.straightdope.com/u/IvoryTowerDenizen)\ **Post date:** [September 16, 2013, 12:34am UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/25 "2013-09-16T00:34:51Z")
> [@Hari\_Seldon](#): > > I beg your pardon but I cared a lot. I once had to choose a text for a course. I found five books that were appropriate. I wrote to all five publishers asking about the price. Two didn’t answer, two wrote me with the price, and the last wrote that that information was proprietary! The price Proprietary? WTF? Anyway, I chose the cheaper of the two who gave me the price. Yeah, I’m with you. I’m curious if what’s been posted makes **Leo Bloom** rethink his position, or the strength of his initial complaint, at all. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [September 16, 2013, 1:41am UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/26 "2013-09-16T01:41:21Z")
> [@Truman\_Burbank](#): > > My wife’s psychotherapy office seems to get fed on a regular basis. My clinic won’t allow it. > Also, back to the OP, I’ve been told by several of our psychiatrists that it is fairly common, with so many similar medications competing against each other, that if an MD finds 3 or 4 antidepressants their clients seem to have good response to, the MD will pretty much begin to confine themselves to those meds, at least initially, with the advantage being that they get to know the medication and it’s effects more intimately than if they were regularly prescribing 10 meds in some sort of haphazard rotation. As a non-MD, I think I’ve even seen this go a bit too far, where a psychiatrist seems to get married to just one or two meds and becomes reluctant to prescribe something else. That’s true with any doctor and class of drugs. Your cardiologist will have their favorite heart drugs, your OB/GYN will have their favorite birth control pills, your family practice doctor will have their favorite antibiotics and blood pressure agents, etc. etc. etc. We pharmacists could often tell who wrote some prescriptions just based on what the drug is. When I worked at the grocery store, the doctors in that town liked a certain diuretic called amiloride and prescribed it quite liberally, so we always had a bottle of 1,000 on the “speedy shelf” where we kept the top 20 or so drugs. After I left that job and went to work at a hospital 150 miles away, I never saw it except for someone who came in on it, and we didn’t have any and couldn’t find any in town so the patient had to use their own supply until the order came in the next day. And when I did clinical rotations on an Indian reservation (gosh, has it really been almost 20 years ago?), the drug reps stopped by even though the Federal government dictated what we stocked. My preceptor hated reps to the point where after they left, he would roll up his sleeves and do a surgical scrub of his arms. 😛 He probably would have taken a shower had one been readily available. As for sexy women reps, the only time I ever saw anything trying to approximate one was a 50-something wannabe whose fake tan was so dark, I thought she was black the first time I saw her (she wasn’t), and wore a black leather suit with a micro-mini skirt and a see-through leopard print blouse underneath. :eek: She looked every bit as ridiculous as this sounds. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [September 16, 2013, 4:28am UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/27 "2013-09-16T04:28:26Z")
Y’all might be interested in reading about [The Sunshine Act.](http://www.ama-assn.org/ama/pub/advocacy/topics/sunshine-act-and-physician-financial-transparency-reports.page) > [@](#): > > Manufacturers are required to collect and track payment, transfer and ownership information beginning Aug. 1, 2013. Manufacturers will submit the reports to the Centers for Medicare & Medicaid Services (CMS) on an annual basis. In addition, manufacturers and group purchasing organizations (GPOs) must report certain ownership interests held by physicians and their immediate family members. > > The majority of the information contained in the reports will be available on a public, searchable website. > > Physicians have the right to review their reports and challenge reports that are false, inaccurate or misleading. … [More from the WSJ](http://online.wsj.com/article/SB10001424127887323455104579014812178937016.html): > [@](#): > > U.S. doctors are bracing for increased public scrutiny of the payments and gifts they receive from pharmaceutical and medical-device companies as a result of the new health law. > > Starting this month, companies must record nearly every transaction with doctors—from sales reps bearing pizza to compensation for expert advice on research—to comply with the so-called Sunshine Act provision of the U.S. health-care overhaul. The companies must report data on individual doctors and how much they received to a federal health agency, which will post it on a searchable, public website beginning September 2014. > > Many doctors say the increased disclosures are making them rethink their relationships with industry, citing concerns about privacy and accuracy, and worry that the public will misinterpret the information. Some fear patients will view the payments as tainting their medical decisions, and will lump together compensation for research-related services with payments of a more promotional nature. … Consulting and speaking fees are an important source of income for some physicians, who can be paid tens of thousands of dollars a year for such services. But now physicians say they will be much more selective about the work they do and what they will accept from industry representatives. Some are even restricting access to their offices by sales reps, or requiring forms that document the value of anything brought to the office, according to medical societies. … The push for greater transparency was driven by concerns that doctors’ prescribing decisions are tainted by the payments and gifts, as well as allegations that drug companies have used payments to induce doctors to prescribe drugs for unapproved, “off-label” uses. Several drug companies have paid large penalties to settle government allegations of off-label marketing, and were required to disclose physician-payment data as conditions of the settlements. > > “The idea is that transparency will encourage doctors to evaluate whether these are appropriate relationships with companies or not,” said Daniel Carlat, a psychiatrist and director of the prescription project at the Pew Charitable Trusts, which supported the Sunshine Act. He expects patients won’t have much of a problem if their doctors receive $200 worth of company-provided lunches, but may question doctors who receive tens or hundreds of thousands of dollars from the industry annually. > > Several drug and device makers—including Pfizer and Eli Lilly LLY +0.68% & Co.—have been posting physician-payment data online for the past few years. Some U.S. states already require companies to report such information. But the Sunshine Act will significantly widen the scope because it applies to most companies—any company whose products are covered by Medicare—and the government’s launch of the database could draw greater public attention. … Many of us have had a long standing policy to not speak to the pharma reps or take anything other than patient samples. Now entire large medical organizations (like mine) are setting up policies forbidding accepting lunches, gifts of any sort, and even limiting samples to a select few that have clear significant patient benefit to have some samples around. The pressure such as it is now comes from incentives originating with the payors and believe it or not these are good things - incentivizing generic use when possible (and appropriate) and compliance with standard of care guidelines including better antibiotic stewardship. (Not treating colds with antibiotics, proving a sore throat is strep before using an antibiotic, not treating acute bronchitis, which is usually viral, with an antibiotic, reserving big guns for when they are needed, etc.) I think there has historically been an issue for some oncologisits who had a margin on chemo given in their offices, and for some fertility clinics. In the old days we used get all sorts of invites for fancy meals. My line was always that we all have a price but that they haven’t met mine yet. Then a detail person left a bouncy ball that light up when you bounced it with the company name it in my box … “Now they are talking my price!” 🙂 ---
**Author:** ![TokyoBayer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tokyobayer/32/13989_2.png) [@TokyoBayer](https://boards.straightdope.com/u/TokyoBayer)\ **Post date:** [September 16, 2013, 3:40pm UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/28 "2013-09-16T15:40:07Z")
> [@IvoryTowerDenizen](#): > > Most places have explicit rules against profs benefiting from selling their own books to their students. I had a fiber optics class from a professor who required his own textbook. He said it was the best one for the class and gave us the $5.00 per book which was his profit. ---
**Author:** ![Doughbag](https://avatars.discourse-cdn.com/v4/letter/d/aeb1de/32.png) [@Doughbag](https://boards.straightdope.com/u/Doughbag)\ **Post date:** [September 16, 2013, 3:47pm UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/29 "2013-09-16T15:47:33Z")
Going by what my wife says about this topic. The drug companies sponsor events (pay speakers, pay lunch, give freebies) if the hospital agrees to buy/promote their drug, they get some other benefits for this –like a once of payment. Now a private GP, might not get much or anything at all these days, maybe a few free samples. ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [September 16, 2013, 4:04pm UTC](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823/30 "2013-09-16T16:04:05Z")
> [@IvoryTowerDenizen](#): > > Yeah, I’m with you. I’m curious if what’s been posted makes **Leo Bloom** rethink his position, or the strength of his initial complaint, at all. 🙂 Sheesh, what is it with you guys? I’ll apologize again, so my account doesn’t get hacked. I come from a family of academics. _I’m_ an academic, for Christ sake, although I’ve never written a textbook. My thesis advisor and close friend did, and it’s actually extraordinarily popular and profitable, that bitch! Is it beyond belief that a simple anecdotal claim may not be an example of a whole “position?” Oh God, I see the error of my ways…! Cite my first sentence! ::flinches in preparation for another blow:: Cite it! I’m begging you, put me out of my misery! But I will never tell the name of the book, the name of the department chairman, or any further details…but the truth that this occurred is forever! God above, God Himself is my Witness! A cynic’s lead in! A false flag! Yankees are nothing but a bunch of fucking overpaid prima donnas. Look at Vernon Wells’ 2013 average. Here’s a [cite](http://espn.go.com/mlb/player/_/id/4166/vernon-wells). [Previous page](https://boards.straightdope.com/t/do-doctors-actually-get-a-cut-for-prescribing-certain-drugs/668823.md?page=1)