Impact of the Physician Payments Sunshine Act on Prescription Drug Utilization and Spending

项目摘要 该研究建议评估《医生支付阳光法案》（PPSA）的早期影响， 《平价医疗法案》规定，要求公开披露医疗产品的付款情况 从2013年8月开始，包括制药公司在内的制造商向医生提供服务。的长期目标 这一建议有助于我们理解如何披露财务关系之间的关系， 医生和制药行业的影响医疗保健的可负担性，效率和成本透明度。 该研究有以下具体目标：1）确定PPSA对整体利用率的影响， 两类药物的处方药支出：他汀类药物和抗精神病药物; 2）确定 PPSA分别针对有和没有仿制药等效物的品牌药物的使用和支出， 以及每个类别中的仿制药; 3）检查医生对PPSA影响的异质性 专业，在PPSA前时期的处方量，以及制药公司的付款。 我们建议分析来自卫生保健成本研究所的数据，其中包含来自以下国家的医疗和药房索赔： 三家全国性保险公司，覆盖5000万人。我们的准实验研究设计利用了这样一个事实， 两个州，马萨诸塞州和佛蒙特州，实施了自己的公开披露立法，类似于 2013年之前的PPSA。我们将采用差异中的差异和事件研究方法，使用MA和VT 作为对照组。我们的治疗组包括其余六个没有报告的东北州 在PPSA之前，因此，我们的研究设计使我们能够估计利用率的差异 和支出措施之前与之后的实施PPSA之间的商业保险 治疗状态下的患者相对于对照状态。 这项拟议中的研究预计将提供有关有效性的首批严格证据之一。 PPSA在提高处方药供应的效率和可负担性方面的作用， 这种影响的基本机制。它还将揭示潜在的意想不到的后果， PPSA。它将提供及时和重要的信息，并进一步开展立法工作， 制药公司和医生之间的财务关系。

PROJECT SUMMARY The study proposes to evaluate the early impact of the Physician Payments Sunshine Act (PPSA), an Affordable Care Act provision that requires public disclosure of payments made from medical product manufacturers, including pharmaceutical companies, to physicians starting August 2013. The long-term goal of this proposal is to contribute to our understanding of how disclosure of financial relationships between physicians and the pharmaceutical industry impacts healthcare affordability, efficiency and cost transparency. The study has the following specific aims: 1) determine the effects of the PPSA on overall utilization of and spending on prescription drugs in the two drug classes: statins and antipsychotics; 2) determine the effects of the PPSA on utilization and spending separately for brand-name drugs with and without generic equivalents as well as generic drugs in each class; 3) examine heterogeneity in the effects of the PPSA by physician specialty, prescribing volume in the pre-PPSA period, and payment from pharmaceutical companies. We propose to analyze data from Health Care Cost Institute containing medical and pharmacy claims from three national insurers covering 50 million individuals. Our quasi-experimental research design exploits the fact that two states, Massachusetts and Vermont, implemented their own public disclosure legislations similar to the PPSA before 2013. We will employ difference-in-difference and event study approaches, using MA and VT as the control group. Our treatment group includes six of the remaining Northeastern states without reporting mandates prior to the PPSA. Therefore, our research design allows us to estimate the differences in utilization and spending measures before versus after the implementation of the PPSA among commercially insured patients in the treatment states relative to the control states. The proposed research is expected to provide one of the first pieces of rigorous evidence on the effectiveness of the PPSA in improving the efficiency and affordability of prescription drug provision, as well as the underlying mechanism of such effects. It will also shed light on potential unintended consequences of the PPSA. It will provide timely and critical information as well as further legislative efforts aimed at curbing financial relationships between pharmaceutical companies and physicians.