Promotional Payments Made to Urologists by the Pharmaceutical Industry and Prescribing Patterns for Targeted Therapies

Urology. 2021 Feb;148:134-140. doi: 10.1016/j.urology.2020.08.080. Epub 2020 Oct 16.


Objective: To measure the association between market-level promotional payments to urologists by the manufacturers of abiraterone and enzalutamide and national prescribing patterns.

Methods: A 20% national sample of the 2015 Part D event file was used to identify patients filling their first prescription for abiraterone and enzalutamide and their prescribing physicians. The 2015 Open Payments data were used to characterize promotional payments made to physicians at the market level. Generalized linear models were then used to measure the relationship between market-level payments to urologists and the physician specialty prescribing abiraterone or enzalutamide for the first time RESULTS: In 2015, 2318 men filled a prescription for abiraterone or enzalutamide by a urologist or medical oncologist. Increasing market-level promotional payments to urologists for abiraterone or enzalutamide was strongly associated with a urologist prescribing either drug-24.3% versus 5.8% of those residing in the markets with highest and lowest level of promotional payments to urologists, respectively (P <.01). Neither the number of urologists residing in a market nor other promotional payment measures (ie, to medical oncologists for these drugs, or to all physicians for all other drugs) were associated with a urologist prescribing either drug.

Conclusion: Promotional payments to urologists at the market level are strongly associated with the specialty of the physician prescribing abiraterone or enzalutamide for the first time. Future work should elucidate the effects of the shift in prescribing patterns on quality of care and financial hardship for men with advanced prostate cancer.

MeSH terms

  • Aged
  • Androstenes / therapeutic use*
  • Benzamides / therapeutic use*
  • Drug Industry / economics*
  • Drug Prescriptions / economics
  • Drug Prescriptions / statistics & numerical data
  • Humans
  • Male
  • Medicare Part D / economics
  • Medicare Part D / statistics & numerical data
  • Nitriles / therapeutic use*
  • Phenylthiohydantoin / therapeutic use*
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / standards*
  • United States
  • Urologists / economics*
  • Urologists / supply & distribution


  • Androstenes
  • Benzamides
  • Nitriles
  • Phenylthiohydantoin
  • enzalutamide
  • abiraterone