Introduction
The covid-19 pandemic has brought unprecedented challenges to the world. In addition to the direct effect of covid-19 infection on people’s health, the pandemic has had numerous spillover effects mediated through changes in lifestyle, economic burden, and disruptions of the healthcare delivery system.1 In 2020 in the US, decreases of 12% in overall prescription volume and 37% in new prescription volume were reported, compared with those in 2019.2 Although the reduction in prescriptions could be influenced by multiple factors (eg, decreased office visits,3 4 initiation and proliferation of telemedicine,3 4 decreased prevalence of other communicable diseases,5 and restrained health seeking behavior6 during the pandemic), the underlying reasons for the change in physicians’ prescription behavior during the pandemic have not been fully elucidated.
One potential mechanism might be related to disruptions in the direct relations between the pharmaceutical industry and individual physicians. Since the establishment of the Open Payments program in 2013 under the Physician Payment Sunshine Act,7 ample evidence has shown that receipt of industry marketing payments influences physicians’ medication prescribing practices and increases the associated healthcare costs.8–12 This financial competing interest has been scrutinized heavily worldwide by policy makers and public health leaders alike, given the possibility of inappropriately influencing clinical decision making among physicians for monetary gain.13 14 Despite widespread concern and criticism, one study has shown that the amount of marketing payments related to the industry has remained stable between 2014 and 2018,15 indicating that increased transparency might not be sufficient to change physicians’ financial relations with the industry.
The covid-19 pandemic, however, substantially altered the healthcare delivery system and the associated activities that physicians normally engage in, such as local and national medical conferences, continuing medical education activities, and academic detailing events. To date, how this disruption might have influenced the interaction between the pharmaceutical industry and individual physicians is unclear. Physician and industry financial relations could have been drastically affected during the covid-19 pandemic, which could have led to a number of potential consequences, including the reduction of both appropriate and inappropriate medication prescriptions by individual physicians. This possible influence of industry payments on physician practicing behavior means that understanding how these financial associations have (or have not) changed during the covid-19 pandemic is critically important.
Therefore, using a national database of US physicians, we examined changes in the value and the number of industry payments made to physicians associated with the covid-19 pandemic compared with the prepandemic baseline using a quasi experimental, difference-in-difference study design. Given the heterogeneous role of each type of payment (eg, meals, travel, consulting fees, speaker compensation, honorariums), we also examined changes in industry payments by the type of payments. Furthermore, because the financial relations between physician and industry might vary by physicians’ gender and specialties,16–18 we investigated whether changes in industry payments due to the pandemic vary by physicians’ gender and specialty.