{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:39:37Z","timestamp":1775554777292,"version":"3.50.1"},"reference-count":41,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,16]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To measure the prevalence and magnitude of industry payments to neurologists prescribing multiple sclerosis (MS) drugs and determine whether payments are associated with prescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data on neurologists prescribing MS drugs from 2015 to 2019 in the Medicare Part D database linked to the Centers for Medicare &amp; Medicaid Services Open Payments database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>7401 neurologists prescribing MS drugs from 2015 to 2019 to Medicare beneficiaries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was the proportion of physicians\u2019 annual prescriptions manufactured by a given company. Generalised linear mixed models were used to evaluate associations between the presence and magnitude of payments and prescribing. The association between prescription volume and the likelihood of receiving payments as well as the value of payments was also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 7401 neurologists, 5809 (78.5%) received payments totalling US$163.6\u2009million between 2015 and 2019. While the median amount per physician was US$779 (IQR, US$188\u2013US$2587), US$155.7\u2009million (95.2%) accrued to the top 10% of payment recipients. Higher prescription volumes were associated with a higher likelihood of receiving any payment type, particularly for consulting services, non-consulting services and travel\/lodging (p&lt;0.001). Among payment recipients, the amount received was positively associated with prescription volume (p&lt;0.001). Receipt of payments was associated with greater likelihood of prescribing the company\u2019s drugs compared with those who received no payments from that company (OR 1.13 (95%\u2009CI 1.11 to 1.15)), with the largest association for non-consulting services, such as being a speaker at an event (OR 1.53 (95%\u2009CI 1.44 to 1.62)). Larger payments were associated with a greater likelihood of prescribing (OR 1.10, 1.26, 1.29 and 1.50 for US$50, US$500, US$1000 and US$5000, respectively), as were longer durations of payments (OR 1.12 for single year to 1.78 for 5 consecutive years) and more recent payments (OR 1.03 for payments made 4 years prior to 1.34 for payments made in the same year).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly 80% of neurologists prescribing MS drugs received at least one industry payment, with higher volume prescribers being more likely to receive payments. Physicians receiving payments were more likely to prescribe the company\u2019s drugs, with a stronger association for payments that were larger, sustained and recent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-095952","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:17Z","timestamp":1756252817000},"page":"e095952","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Industry payments to US neurologists related to multiple sclerosis drugs and prescribing (2015\u20132019): a retrospective cohort study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-8917","authenticated-orcid":false,"given":"Ahmed","family":"Sayed","sequence":"first","affiliation":[{"name":"Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA"},{"name":"Faculty of Medicine, Ain Shams University, Cairo, Egypt"},{"name":"Rochester General Hospital, Rochester, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3448-6339","authenticated-orcid":false,"given":"Ravi","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3845-3606","authenticated-orcid":false,"given":"Reshma","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and the Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA"},{"name":"Yale Collaboration for Regulatory Rigor, Integrity and Transparency (CRRIT), Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1818-8622","authenticated-orcid":false,"given":"Alejandro","family":"Rivero-de-Aguilar","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph S","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and the Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA"},{"name":"Yale Collaboration for Regulatory Rigor, Integrity and Transparency (CRRIT), Yale School of Medicine, New Haven, Connecticut, USA"},{"name":"Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"2025123106473497000_15.8.e095952.1","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1001\/jamaneurol.2018.4905","article-title":"Clinical Outcomes of Escalation vs Early Intensive Disease-Modifying Therapy in Patients With Multiple Sclerosis","volume":"76","author":"Harding","year":"2019","journal-title":"JAMA Neurol"},{"key":"2025123106473497000_15.8.e095952.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2013.07.330"},{"key":"2025123106473497000_15.8.e095952.3","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1243589","article-title":"Switching to second line MS disease-modifying therapies is associated with decreased relapse rate","volume":"14","author":"Marriott","year":"2023","journal-title":"Front Neurol"},{"key":"2025123106473497000_15.8.e095952.4","first-page":"e1810","article-title":"The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs","volume":"98","author":"Bebo","year":"2022","journal-title":"Neurology (ECronicon)"},{"key":"2025123106473497000_15.8.e095952.5","doi-asserted-by":"crossref","unstructured":"de Havenon A , Delic A , Dehoney S , et al . Five-Year Trends in Payments for Neurologist-Prescribed Drugs in Medicare Part D. Neurology (ECronicon) 2021;96. doi:10.1212\/WNL.0000000000011712","DOI":"10.1212\/WNL.0000000000011712"},{"key":"2025123106473497000_15.8.e095952.6","unstructured":"Centers for Medicare and Medicaid Services . Medicare provider utilization and payment data: part D prescriber. Available: https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/Medicare-Provider-Charge-Data\/Part-D-Prescriber.html [Accessed 27 Nov 2023]."},{"key":"2025123106473497000_15.8.e095952.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-076797","article-title":"Tackling the excesses of pharmaceutical marketing and promotion","volume":"385","author":"Gupta","year":"2024","journal-title":"BMJ"},{"key":"2025123106473497000_15.8.e095952.8","unstructured":"US Department of Justice Press Release . Sanofi agrees to pay $11.85 million to resolve allegations that it paid kickbacks through a co-pay assistance foundation. n.d. Available: https:\/\/www.justice.gov\/usao-ma\/pr\/sanofi-agrees-pay-1185-million-resolve-allegations-it-paid-kickbacks-through-co-pay"},{"key":"2025123106473497000_15.8.e095952.9","unstructured":"US Department of Justice Press Release . Novartis pays over $642 million to settle allegations of improper payments to patients and physicians. n.d. Available: https:\/\/www.justice.gov\/opa\/pr\/novartis-pays-over-642-million-settle-allegations-improper-payments-patients-and-physicians"},{"key":"2025123106473497000_15.8.e095952.10","unstructured":"US Department of Justice Press Release, Biogen Inc . Agrees to pay $900 million to settle allegations related to improper physician payments. n.d. Available: https:\/\/www.justice.gov\/opa\/pr\/biogen-inc-agrees-pay-900-million-settle-allegations-related-improper-physician-payments"},{"key":"2025123106473497000_15.8.e095952.11","doi-asserted-by":"publisher","DOI":"10.7326\/M20-5665"},{"key":"2025123106473497000_15.8.e095952.12","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1001\/jamainternmed.2019.1082","article-title":"Association Between Industry Payments to Physicians and Gabapentinoid Prescribing","volume":"179","author":"Rhee","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2025123106473497000_15.8.e095952.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.i4189","article-title":"Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study","volume":"354","author":"Fleischman","year":"2016","journal-title":"BMJ"},{"key":"2025123106473497000_15.8.e095952.14","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1001\/jamainternmed.2016.2765","article-title":"Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries","volume":"176","author":"DeJong","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2025123106473497000_15.8.e095952.15","unstructured":"Centers for Medicare and Medicaid Services . Open payments. Available: https:\/\/www.cms.gov\/openpayments\/ [Accessed 07 Jul 2023]."},{"key":"2025123106473497000_15.8.e095952.16","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-022-11193-w"},{"key":"2025123106473497000_15.8.e095952.17","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2021.693017","article-title":"Early High Efficacy Treatment in Multiple Sclerosis Is the Best Predictor of Future Disease Activity Over 1 and 2 Years in a Norwegian Population-Based Registry","volume":"12","author":"Simonsen","year":"2021","journal-title":"Front Neurol"},{"key":"2025123106473497000_15.8.e095952.18","first-page":"e1041","article-title":"Initial high-efficacy disease-modifying therapy in multiple sclerosis: A nationwide cohort study","volume":"95","author":"Buron","year":"2020","journal-title":"Neurology (ECronicon)"},{"key":"2025123106473497000_15.8.e095952.19","unstructured":"R Core Team . R: a language and environment for statistical computing. R foundation for statistical computing. Vienna, Austria, 2022. Available: https:\/\/www.R-project.org\/"},{"key":"2025123106473497000_15.8.e095952.20","doi-asserted-by":"publisher","DOI":"10.32614\/RJ-2017-066"},{"key":"2025123106473497000_15.8.e095952.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9868.2010.00749.x"},{"key":"2025123106473497000_15.8.e095952.22","unstructured":"Lenth R . emmeans: estimated marginal means, aka least-squares means_. R package version 1.10.6. 2024. Available: https:\/\/CRAN.R-project.org\/package=emmeans"},{"key":"2025123106473497000_15.8.e095952.23","doi-asserted-by":"crossref","unstructured":"Wickham H . ggplot2: elegant graphics for data analysis. Springer-Verlag New York, 2016.","DOI":"10.1007\/978-3-319-24277-4_9"},{"key":"2025123106473497000_15.8.e095952.24","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1001\/jamaneurol.2019.2711","article-title":"Trends in Prices, Market Share, and Spending on Self-administered Disease-Modifying Therapies for Multiple Sclerosis in Medicare Part D","volume":"76","author":"San-Juan-Rodriguez","year":"2019","journal-title":"JAMA Neurol"},{"key":"2025123106473497000_15.8.e095952.25","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005347"},{"key":"2025123106473497000_15.8.e095952.26","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.26858"},{"key":"2025123106473497000_15.8.e095952.27","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517751049"},{"key":"2025123106473497000_15.8.e095952.28","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0423"},{"key":"2025123106473497000_15.8.e095952.29","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.mayocp.2021.08.026","article-title":"Association Between Payments by Pharmaceutical Manufacturers and Prescribing Behavior in Rheumatology","volume":"97","author":"Duarte-Garc\u00eda","year":"2022","journal-title":"Mayo Clin Proc"},{"key":"2025123106473497000_15.8.e095952.30","doi-asserted-by":"crossref","DOI":"10.1212\/CPJ.0000000000200424","article-title":"Industry Payments and Branded Glatiramer Acetate Prescribing in the US Medicare Program","volume":"15","author":"Hartung","year":"2025","journal-title":"Neurol Clin Pract"},{"key":"2025123106473497000_15.8.e095952.31","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1001\/jama.2024.4682","article-title":"Intravascular Microaxial Left Ventricular Assist Device Manufacturer Payments to Cardiologists and Use of Devices","volume":"331","author":"Dhruva","year":"2024","journal-title":"JAMA"},{"key":"2025123106473497000_15.8.e095952.32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.17436"},{"key":"2025123106473497000_15.8.e095952.33","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.211"},{"key":"2025123106473497000_15.8.e095952.34","doi-asserted-by":"crossref","DOI":"10.1186\/s41073-019-0087-1","article-title":"Impact of US industry payment disclosure laws on payments to surgeons: a natural experiment","volume":"5","author":"Rhee","year":"2020","journal-title":"Res Integr Peer Rev"},{"key":"2025123106473497000_15.8.e095952.35","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1161\/STROKEAHA.119.027967","article-title":"Industry Payment to Vascular Neurologists","volume":"51","author":"Nalleballe","year":"2020","journal-title":"Stroke"},{"key":"2025123106473497000_15.8.e095952.36","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1212\/WNL.0000000000008067","article-title":"Scope and nature of financial conflicts of interest between neurologists and industry: 2013-2016","volume":"93","author":"Robbins","year":"2019","journal-title":"Neurology (ECronicon)"},{"key":"2025123106473497000_15.8.e095952.37","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1001\/jama.2024.1989","article-title":"Industry Payments to US Physicians by Specialty and Product Type","volume":"331","author":"Sayed","year":"2024","journal-title":"JAMA"},{"key":"2025123106473497000_15.8.e095952.38","doi-asserted-by":"crossref","first-page":"2452","DOI":"10.1001\/jama.2022.20794","article-title":"Comparison of Industry Payments to Physicians and Advanced Practice Clinicians","volume":"328","author":"Zhang","year":"2022","journal-title":"JAMA"},{"key":"2025123106473497000_15.8.e095952.39","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1001\/jama.2024.7832","article-title":"Industry Payments to Physicians Endorsing Drugs and Devices on a Social Media Platform","volume":"331","author":"Persaud","year":"2024","journal-title":"JAMA"},{"key":"2025123106473497000_15.8.e095952.40","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-009-0989-6"},{"key":"2025123106473497000_15.8.e095952.41","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-720X.2012.00683.x"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-095952","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:49:46Z","timestamp":1767192586000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-095952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,26]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bmjopen-2024-095952"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-095952","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}