July 28, 2012

The Bottom Line On High-Prescribers

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The following high-prescribing physicians and a physician assistant were consultants or speakers for the companies that manufactured the drugs they dispensed:

• Dr. Irene Abramovich, a West Hartford psychiatrist. In 2008, she was the top Medicaid prescriber of Zyprexa, writing 672 prescriptions—nearly double the amount of the next highest-prescriber. In the following year, she dispensed 292 Zyprexa prescriptions, ranking fifth on the list. In 2009 and 2010, she was paid $68,563 in speaking fees by Eli Lilly and $4,690 in travel compensation.

In 2010 and 2011, she was the No. 1 prescriber of Janssen’s Invega, and was paid $15,975 to participate in the company’s “speaker bureau.” From 2008 to 2010, she also was a top-10 prescriber of AstraZeneca’s Seroquel, writing out 3,344 prescriptions. AstraZeneca paid her $9,357 in 2010 and 2011.

Abramovich said her prescribing was not influenced by her pharmaceutical pay. She also said she is no longer a speaker for AstraZeneca.

• Dr. Kathleen Degen, a Norwich psychiatrist.  In 2008 and 2009, she was a top-10 prescriber of Risperdal, marketed by Janssen. In 2009 and 2010, she was in the top 10 for Eli Lilly’s Zyprexa. In 2009 and 2010, she collected $30,241 in speaking and travel fees from Lilly, and $1,259 in travel and business meals from Janssen. She did not return messages.

• Dr. Michael Brennan of Fairfield. In 2010 and 2011, he was the top prescriber of Cephalon’s Actiq, writing out 218 prescriptions—nearly double the number of the next highest prescriber. In those two years, he was paid $31,997 by Cephalon for consulting, speaking, travel and meals. He also is a paid speaker for Purdue, which markets OxyContin, of which he was among the top four prescribers from 2008 to 2011.

Brennan said he treats patients in severe pain who have been referred to him by other pain doctors, and that he uses Actiq only in select cases. He noted that his Actiq prescribing had fallen off since 2008—from 277 prescriptions, to 105 last year—in part because of increased scrutiny of off-label prescribing.

Brennan initially said he signed-on a speaker for Cephalon because it was a way for him to “educate and advocate” about pain management. He later conceded that his speeches have to follow drug-company scripts, which he described as “basically (reading) the package insert from the drugs.” But he said he still finds the gatherings productive, and insisted that the promotional work had no impact on his prescribing.

• Dr. Bassam Awwa, a New London psychiatrist. In 2010 and 2011, he was among the top-10 prescribers of Pfizer’s Geodon. He received $10,680 from Pfizer in 2010 and 2011 for speaking, travel and meals. He also was the sixth-highest prescriber of Seroquel in 2010, when he was paid $7,800 in speaking fees from AstraZeneca. He said his prescribing was driven by his patients’ needs and had no connection to his role as a speaker for a number of drug companies.

• Dr. Velandy Manohar, a Middletown psychiatrist. In 2011, he was a top-10 prescriber of Seroquel. In 2010, he received $4,800 in speaking fees from AstraZeneca.

Manohar said he started using Seroquel in 2010 as an adjunct medication for major depressive disorder, and was approached by AstraZeneca to promote the drug at dinners. When his prescribing fell off, and he became a vocal critic of the drug-approval process, he was no longer asked to speak, he said.

• Jon Lum, a physician assistant in Waterbury. In 2008, he was in the top 10 prescribers of Pfizer’s Xanax. In 2010, he earned $510 in speaking fees and meals from Pfizer. He also was among the top five prescribers of OxyContin and Roxicodone in each of the last four years.

Thirty-seven other physicians received smaller payments for business meals and other items from the drug companies, from 2008- 2011. Lunches and dinners, while inexpensive compared to speaking fees, are a venue for drug companies to pitch their products.

Records show that for Geodon alone, 18 of the 23 physicians on the high-prescriber list, or 78 percent, had business meals from Pfizer. Geodon is approved for treating adults with schizophrenia and bipolar disorder, but has been promoted for off-label uses.

Pfizer paid millions of dollars in 2009 to settle allegations of fraudulent marketing of Geodon and other drugs, including charges of paying illegal kickbacks to doctors.

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