RENEE MONTAGNE, HOST:

It's MORNING EDITION from NPR News. I'm Renee Montagne.

DAVID GREENE, HOST:

And I'm David Greene. Good morning. We're digging deeper into the relationship between drugmakers and the doctors who prescribe their drugs. Bystolic is a popular high blood pressure medication. It's made by Forest Laboratories. ProPublica, the nonprofit investigative news organization, examined new data and found that frequent prescribers of this drug often have financial ties to the drug's maker. We sat down with ProPublica reporter Charles Ornstein. He explained why this is significant.

CHARLES ORNSTEIN: What's new here is that we obtained information from Medicare. Medicare pays for about one out of every four prescriptions in the country. And so we took this data and linked it up with the payment data that we received to look for any connections that may exist there.

GREENE: OK. What connections did you find?

ORNSTEIN: We found that with a number of really highly marketed drugs, drugs like Bystolic, that many of the top prescribers of those drugs within the Medicare program also receive money for speaking from the companies that made those drugs.

GREENE: And this is something, though, that we believe might have been going on for a long time. I mean, pharmaceutical companies have always been accused of...

ORNSTEIN: That's right. Pharmaceutical companies have had access to this data. They've paid millions of dollars for it every year. So they know what they spend on doctors for speaking and consulting. And then they track very, very closely their return on investment. We've seen these pop up in dribs and drabs in these whistleblower lawsuits where they make mention to the analyses that these companies do, the return on investment analyses, and where they track it super closely. But as a public we have not known the drugs that doctors prescribe, nor have we known sort of the contours of how these relationships affect prescribing.

GREENE: OK. So you looked closely at this one drug, Bystolic, for high blood pressure, and you found that doctors who are getting money from the company that makes it are some of the biggest prescribers of the drug over generic alternatives. What has been the response from the people involved - the company and these physicians?

ORNSTEIN: So it's 17 of the 20 top prescribing doctors are speakers for the maker, Forest. These doctors say they think of this drug as better. This drug has fewer side effects than other, these are called beta blockers. So it has fewer side effects than other beta blockers and they think that it just works well for their patients. But as we talked to experts across the country, what they said to us was that they did not think that there was any evidence to show that this drug was any better than the existing beta blockers, but it certainly was a lot more expensive.

GREENE: What about the company, Forest Labs? What do they - how have they responded to this?

ORNSTEIN: They responded to us that this is an important treatment option, that it had undergone studies and had performed well. But they didn't reiterate the point that it was superior; they just called it an important treatment option. I think what you find with a lot of pharmaceutical companies is they're sort of boxed in by what the FDA allows them to say so the phrase "important treatment option" is one that you hear a lot by companies to promote their drugs.

GREENE: So you're getting some corporate-speak here, but corporate-speak that they have to do.

ORNSTEIN: Absolutely.

GREENE: You mentioned money. These doctors are prescribing this drug Bystolic over the generic alternatives. That's probably costing the government a lot more money since, you know, generics are usually cheaper.

ORNSTEIN: Right. So one prescription for Bystolic is about $80 a month. By comparison, a prescription for a generic is less than $10 a month. So that's a difference of about $70 per prescription. If you multiply that by a million prescriptions you're at $70 million. And the federal government is paying a big chunk of that in terms of the subsidies it's providing in Medicare Part D, which is the name of the drug plan. So that's just one drug. If you add in a whole bunch of drugs, you can see how this starts adding up to real money.

GREENE: Could there be cases are prescribing something more often than they should that might not be as effective in terms of treating? I mean, where you can actually dealing with someone's health here.

ORNSTEIN: When you look at the diabetes drug Avandia, which is a drug that a couple of years ago was restricted because of risks that came to light, GlaxoSmithKline, which is the maker of Avandia, was spending a lot of money on physicians to speak on its behalf. And so the question that we weren't able to answer because our data is more recent is, you know, was there a connection back then?

But I think that as new risks of drugs come out we'll now have the information to look back and see are the top prescribers of those drugs also people who have financial relationships with the company. And then we'll be able to put the pieces together and do the analysis.

GREENE: So what you're saying is that as we get more of these numbers, I mean, a lot more investigation to do. There could be times where someone might be prescribed a drug from a doctor who's getting money from a company and actually a different drug might be better for them.

ORNSTEIN: Well, we can't turn the page backward. Beginning next year, every drug company and every medical device company is going to have to begin reporting the payments that they make to doctors across the country. That's going to be a totally new universe. Right now we're talking only about 15 drug companies that we know about.

You also can't take back this information that we're getting from Medicare. So when you put this together, you're going to learn a lot more about how these relationships affect physicians and their prescribing.

GREENE: Charles, thanks so much. Thanks for bringing this report to us.

ORNSTEIN: Thanks for having me.

GREENE: He's a reporter for ProPublica, the nonprofit investigative news organization.

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