Introduction

With the 2020 elections fast approaching, Medicare is currently one of the hottest topics in the United States, and advocacy for policies targeting the astronomical costs of many prescription drugs has been mounting. According to a report from the latest KFF Health Tracking Poll,

“While a majority of adults say prescription drugs have made lives better, most say the cost is unreasonable.” KFF Health Tracking Poll

We must ask ourselves how and why prescription drugs ate often so unreasonably priced for the consumer market. Is it truly a direct result of necessary research and development costs required to stimulate competition and innovation in the pharmaceutical industry? Or are these lofty prices perpetuated by the self-interests of those who benefit from Big Pharma’s monopoly on drugs?

Policy makers are increasingly engaging in attempts to make prescription drugs more affordable to the American public. One major approach that caught our group’s attention is the creation of policies that encourage healthcare providers to prescribe their patients with cheaper generic alternatives to expensive brand name drugs.

We are well aware that Big Pharma uses tactics of bribery to encourage healthcare providers to prescribe an agenda of expensive brand name drugs to their patients, whether it be by means of free trips, free food, swag, or even open payments that put money directly in physicians’ pockets. An additional layer of suspicion can arise when we consider the addictive qualities of many of these drugs. Our country is suffering from a crippling opioid epidemic, which many believe to be largely fueled by the overprescription of opiates.

This climate of high prescription drug costs, Big Pharma’s monopoly on drugs, and the opioid epidemic led our group to wonder about the correlation between the suspected bribery of healthcare providers by drug manufacturers through open payments and their prescription patterns. For this project we will be addressing the following questions:

Is there any association between the number of prescriptions written by healthcare providers, and the amount of money that they recieve in the form of open payments from drug manufacturers?

More specifically, is there an association between the number of opioid prescriptions written by healthcare providers and the amount of money that they recieve in the form of open payments from drug manufacturers?

In order to explore these questions, we created merged version of the Open Payments data and the Medicare Part D Prescriber data from our original Project Brainstorm. We also merged those data sets with a new dataset we found, which has Medicare Part D Opioid Prescriber data From the original data sets, it keeps the doctor’s name, their state of residence, the amount of payment they received from a corporation, and both the total amount of claims made and the amount of opioid claims made.

Summary Information

The data set has entries from 285366 different doctors. Among these doctors, the average amount paid to them by corporations is $151.12, and the average amount of opioid claims made by these doctors is 169.2 claims. Overall, the average opioid prescribing rate (or, how many total claims were opioid claims) for all doctors is 11.4%, and out of the doctors represented in this data set, 22 of them only made opioid claims, with an opioid prescription rate of 100%.

Summary Data Table

Payments.to.Physicians Opioid.Claims.by.Physicians
Mean $151.12 169.20
Maximum $2503360.98 20599.00
Minimum $0.03 0.00
Median $17.05 35.00
Standard Deviation $7401.9 487.23

Observations:

  • There is a $134.07 difference between the mean and median for payments to physicians, and a difference of 134.2 in opioid claims made by those same physicians.
  • As shown by the standard deviation and the first observation, there is a very large range of values in both payments and opioid claims. The much larger means, when compared to the medians, also shows the presence and influence of more extreme values.

Data Visualizations

Opioid Claims vs. Non-Opioid Claims

The purpose of the stacked bar chart below is to show the ratio of opioid prescription claims (represented in red) to non-opioid prescription claims (represented in blue) within each U.S. census region. The total number of prescriptions combining non-opioid and opioid claims is the highest by far in the Southern region of the United States, while it is the lowest in the Northeast. The number of opioid prescription claims in the Midwest and West regions of the United states appear to be very similar, whereas when comparing the number of opioid prescription claims in the Northeast and Southern regions there is quite a noticable difference. The number of opioid prescription claims in the Southern region is the highest of any U.S. region.

Opioid Claims vs. Payments (Doctors who only wrote Opioid Claims)

The purpose of the scatterplot below is to assess the correlation between total payments recieved and total opioid claim count for providers who ONLY wrote opioid prescriptions. This scatterplot is also colored by U.S. census region so that we can see in which part of the country each of these providers practices. It can be observed that the majority of providers who solely wrote opioid prescriptions were in the Southern region of the United States. It can also be seen that no providers from the Midwest wrote solely opioid prescriptions. Finally, we can see a slight positive correlation between total payments recieved and opioid prescription claims up to approximately $80, and then the correlation dissipates.

Opioid Claims vs. Payments (Top 50 Opioid Prescribers)

The purpose of the scatterplot below is to assess the correlation between total payments recieved and total opioid claim count for the top 50 opioid prescribers in the United States. This scatterplot is also colored by U.S. census region so that we can see in which part of the country each of these providers practices. It can be clearly observed that the vast majority of the top 50 opioid prescribers practice in the Southern region of the United States. Otherwise, there does not appear to be any strong correlation between total payments recieved and total opioid claim count for this subset of providers - in fact, there is a dense cluster between 10,000 and 20,000 opioid prescription claims, and between $0 and $50 total payments recieved.

Opioid Claims vs. Payments (Top 50 Highest Paid Doctors)

The purpose of the scatterplot below is to assess the correlation between total payments recieved and total opioid claim count for the 50 providers who recieved the most money in open payments. This scatterplot is also colored by U.S. census region so that we can see in which part of the country each of these providers practices. There would appear to be a fairly diverse regional distribution of providers (meaning that no one U.S. census region stands out as dominant for this subset of providers). In addition, there does not appear to be any strong correlations between total payments recieved and total opioid claim count for this subset of providers.

Total Opioid Claims Made in State

The heat map below shows the total amount of opioid claims made by providers in each state. The amount of claims made in each state is represented by a continuous color scale from black to red, with red signifying a higher number of opioid claims for that particular state. Grey states had no recorded opioid claims made by providers. In this map, It seems that the states of California, Texas, and Florida have the highest amount of opioid claims made by providers in 2017. Meanwhile, the states with no recorded opioid claims are New Hampshire, New Jersey, Connecticut, Vermont, and Rhode Island. There is, however, a possibility that state population is a confounding variable in this data. To accomodate this, a future iteration of this map may compare the ratio of opioid claims to total claims, rather than the total opioid claims.