Xarelto Promotion Resulted in $28.4M in Payments for Doctors in 2015: Report

In an effort to promote Xarelto and increase sales, a new report indicates the maker of the controversial anticoagulant doled out $28.4 million for U.S. doctors last year, in the form of speaking fees, dinners and gifts. 

The independent, public-interest news organization ProPublica released new data for its Dollars for Docs database earlier this week, highlighting the top five drugs associated with payments to doctors in 2015.

The investigation found that companies pay about $2 billion in general payments for more than 600,000 physicians each year, and 2015 was no different.

According to the data, Xarelto topped the list of drugs associated with promotional payments to doctors. It was followed by $24.9 million in payments stemming from the promotion of Humira, $20.9 million linked to the diabetes drug Invokana, $19.2 million given to doctors to promote the hepatitis C drug Viekira, and $18.8 million in payments to promote Xarelto’s competing blood thinner, Eliquis.

ProPublica’s findings highlight the potential conflicts of interests these payments create, as doctors on the dole are more likely to prescribe those drugs to their patients.

“Combining previous payment data with prescribing data from the federal Medicare program, we’ve shown that physicians who receive payments from the industry tend to prescribe more brand-name drugs than those who don’t,” ProPublica investigators wrote. “Several academic studies later had similar findings.”

Xarelto Litigation

Concerns over the promotional payments come as thousands of Xarelto lawsuits are moving forward against the drug makers, alleging that the anticoagulant was recklessly promoted without adequate warnings about the risk of severe and fatal bleeding.

Xarelto (rivaroxaban) is part of a new class of blood thinners introduced in recent years as a replacement for warfarin, which had been the go-to anticoagulation treatment for decades. Since it was approved in 2011, this new-generation treatment has been commonly prescribed instead of warfarin for reduction of the risk of blood clots and strokes among patients with atrial fibrillation, or following hip or knee replacement surgery.

Amid allegations that the drug makers failed to adequately warn about the risk of bleeding associated with the new-generation drug, more than 11,000 Xarelto lawsuits have been filed in courts throughout the U.S.

Each of the complaints raise similar allegations, indicating that Xarelto caused uncontrollable bleeding problems, resulting in serious injury or wrongful death.

While there is a known reversal agent that can stop the blood thinning effects of warfarin, there were no similar antidotes available for Xarelto at the time it was introduced, placing doctors in a position where they were unable to control many bleeding problems.

Lawsuits also allege that the drug makers provided false and misleading information about the importance of blood monitoring on Xarelto, marketing the drug as easier to use and indicating that it does not require close testing like warfarin. However, independent studies published after the medication was introduced have suggested that Xarelto monitoring may help identify patients at greater risk of bleeds.

As part of the coordinated proceedings in the federal Xarelto litigation, a small group of “bellwether” cases are being prepared for early trial dates, which are expected to begin early next year to help gauge how juries may respond to certain evidence that has been obtained during the discovery process.

While the outcome of these early bellwether trials will not be binding in other cases, they may facilitate Xarelto settlement negotiations that will avoid the need for thousands of individual cases to go to trial nationwide.